Tuesday, June 22, 2010

Trouble inside VIHA?

Check out this intriguing series of letters and opinion pieces from doctors and VIHA directors, all published in the Times Colonist in the past month. I've started with the June 9 editorial that got things rolling, followed by the three letters that have run so far revealing a whole lot of internal dissent about the cuts to mental-health services this past year. I'll be writing about this issue in my column on Friday, June 25.

A terrible failure on mental illness
Times Colonist (Victoria)
Wed Jun 9 2010

A terrible failure on mental illness

There is no worry greater than being the parent of a child with a serious mental illness or addiction. Any illness suffered by a family member is, of course, traumatic.

But for most ailments and injuries, especially critical ones, there is support and help. If your child has cancer, the health care system provides remarkable care; support services help the family; friends and neighbours pitch in. Parents know that even after they are gone, their child will be supported.

None of those things is true for people suffering with mental illness. We would not turn someone away requiring critical cancer care; we routinely tell people dealing with serious -- potentially fatal -- mental illness that there just isn't space to provide care. Patients are stigmatized and families isolated.

The consequences are terrible for individuals, families and society.

The tragic stabbing death of 15-year-old Justin Wendland has refocused attention. The man charged with murder has a long history of mental illness and addiction.

But it should hardly take such a case to remind us of this health care failure. Look at downtown streets and the people camped along Pandora Avenue most nights.

Most are not well. Of some 1,400 homeless people in the city, about 40 per cent have a mental illness; 50 per cent have an addiction. Many are dealing with both.

That means that some 800 sick people are warehoused on the streets with little or no support or treatment. Often, they lurch from crisis to crisis. When things get bad enough, there is a brief, expensive response from the system, in the form of acute care or jail time. Then they are left on their own until the next crisis.

It's not easy to provide treatment. Some patients reject help; others shun medication that could assist in managing their illnesses (sometimes with good reason). Others are just terribly difficult. Involuntary treatment is sometimes necessary.

But we are a long, long way from having to worry about finding ways to persuade the recalcitrant to accept care.

Even when people want care -- when their families are desperate -- there are likely no beds available and little support. The Vancouver Island Health Authority cut mental health services in the capital region, both psychiatric beds and community support. Patients who should be in the hospital, according to their doctors, aren't. Some 350 patients lost the support of mental health caseworkers.

VIHA is simply balancing priorities against inadequate funding. Mental illness is a lesser priority.

But the health system's savings are offset by the extra costs for policing, shelters and crisis response.

It must be noted that mental illness, like many other diseases, can be managed. Millions of people live happy, productive lives. Even those seriously ill are rarely -- almost never -- a danger to anyone but themselves.

But the extreme cases are a reminder of the high price we pay every day for failing to provide adequate mental health care.

Services increased to the mentally ill
Times Colonist (Victoria)
Sat Jun 12 2010

Re: "A terrible failure on mental illness," June 9.

Over the past three years, VIHA has greatly increased funding in Victoria for services to the homeless, mentally ill and addicted. This includes an increase of more than $6 million every year toward enhancing services for those who suffer from mental illnesses or addiction, including those living on the streets, and we are seeing excellent results.

In Victoria, the establishment of four Assertive Community Treatment outreach teams proactively connects individuals who suffer from serious mental illnesses and-or addictions, particularly those who are homeless or poorly housed in the downtown, with the services they need and has reduced the number of individuals coming to emergency rooms. Clients are now better able to manage their mental illnesses long term with the ongoing contact and support from these teams.

We have tripled the number of medical detox beds and tripled stabilization and supportive recovery beds for those in long-term recovery from addictions.

Services provided at a number of supported housing apartments for mental-health clients continue to help them transition into wellness and reintegrate into the community.

This past year, we have shifted some of our funding in order to provide services to those communities in the Central and North Island communities that have been significantly underserved. This meant a reduction in services in the Greater Victoria area.

We can and will do more. We all recognize that it will take the combined and determined efforts of many agencies, and the support of all citizens, to ensure that everyone has a safe place to live, their basic needs met and a valued role in our community.

Alan Campbell
Director, Mental health and addictions services Vancouver Island Health Authority

No confidence in VIHA's mental-health efforts
Thu Jun 17 2010
Page: A14
Source: Special to Times Colonist

The letter from Alan Campbell, Vancouver Island Health Authority director of mental health, suggests he must be living on a different planet than the majority of front-line psychiatrists and case managers who are trying to deal with cuts to services for their chronically ill mental health patients in Victoria ("Services increased to the mentally ill," June 9).

On my planet, the following facts are the reality:

- A motion passed at the Nov. 10, 2009, meeting of the department of psychiatry, south Island, condemned the unacceptable way in which budget reductions in mental health took place, the lack of clinical consultation, the significant failure of managers and co-ordinators to share information and the resulting low morale, despondency and mistrust that had ensued.

- A draft e-mail in November 2009 from one of Campbell's managers stated, "With the reduction of six case management staff in early December, the case management program will need to discharge a total of over 300 individuals in the next few weeks." Case managers are afraid to speak out about this, or any other matter affecting their patients, for fear of retribution by senior management. This is not a healthy state of affairs.

- On Nov. 30, 2009, and because of continued frustration with management, a group of nine psychiatrists signed a letter of complaint about a situation in the Mental Health Centre that also referred to low morale affecting staff. Nothing was done to address the complaints; the reply from Campbell on Dec. 3 said he was directly involved in the decisions made and was accountable.

- On April 22, 2010, we received notice that Dr. Anthony Barale was closing his outpatient neuropsychiatry practice at Victoria General Hospital. He complained about the lack of concern by VIHA for brain-injured patients, who are amongst the most complex in the system. He said they have organic brain conditions, addictions, concurrent psychiatric disorders and multiple medical conditions, yet mental health is currently putting up as many barriers as possible to this patient group. He is no longer prepared to support a system that is failing patients and their families.

- Dr. Adam Gunn has tendered his resignation from the Schizophrenia Clinic and Affective Disorders Clinic in Victoria effective June 26. He referred to difficulty with the profoundly negative effects that VIHA cuts have had on patient care, causing serious concerns about safety and the expectation that there will be dangerous consequences, with patients' lives at stake.

He said he could no longer be a part of it. He went on to state that the quality of care has already been severely eroded, and accessing treatment services for quite ill patients is now extremely difficult and in some cases impossible. As well, he felt that VIHA has now become an unhealthy workplace, with patients, their families and his colleagues deserving better and believed that bad things will follow from this in the coming months. Other VIHA psychiatrists are considering resigning because of similar concerns.

Meanwhile, VIHA funds programs for patients to do yoga, Qigong and power walking. Not much use to the patients of Barale and Gunn, nor to the 194 patients I saw in 2009 who suffer from schizophrenia, bipolar mood disorder and serious depression. Not much use to the 300 Mental Health Clinic patients who have been disenfranchised with the loss of six of their case managers.

Mental health management continues to bury its head in the sand and ignore a very large group of chronically mentally ill patients. They and their families rarely speak out; they do not cause problems downtown, and are no more likely to commit crime than the general population. Indeed most of my patients have been afraid to go downtown or near Our Place because of the presence of the drug abusers who present a threat and are most likely to commit crimes, from theft to serious assaults.

The problems downtown have been erroneously blamed on the mentally ill. Their incidence in the population has remained static, but there has been a totally unacceptable explosion in the numbers of drug addicts who have been allowed to take over our city.

Repeatedly, I have called for an audit of actions taken by mental health management in the last three years, but this has fallen on deaf ears.

André Masters is a psychiatrist who has worked in mental health for 49 years in the United Kingdom, Saskatchewan and Victoria. He recently retired from a position as a consultant in general psychiatry at the Victoria Mental Health Centre, but continues to do part-time consultations for the Mental Health Service in Victoria.

Mental-health improvements up to us
Times Colonist (Victoria)
Sat Jun 19 2010

Re: "No confidence in VIHA's mental health efforts," June 17.

There are, to be sure, profound differences in the perspectives of Dr. André Masters and Alan Campbell, who retires next month after a lifetime serving the needs of the mentally ill in B.C.

These differences go some way to explain their differing views of the progress made in serving the mentally ill on Vancouver Island over the past several years.

As Vancouver Island Health Authority director of mental health, Campbell has to support the needs of all those who live on Vancouver Island who are mentally disordered. He cannot favour those with mental illnesses judged as respectable or unavoidable and neglect those whose impairments are secondary to a lifestyle that might have been prevented.

He must seek to provide fair funding for all communities, redressing the gross imbalance that has favoured the south island. VIHA now spends $6 million more annually in new mental health and addictions funding in Victoria. So, despite reductions to service in Victoria totalling about $1.5 million last year, there has been a net increase of nearly $4.5 million over the past few years.

Masters has been an exceptional advocate for his own patients; but he has not had to be concerned that continuing to favour some continues to disadvantage many.

We are, fundamentally, on the same side. We recognize that mental illness is the cause of the greatest loss to our quality of life and the largest economic burden to our society.

The answer lies with our population, who must decide how much value to attribute to mental health and addiction care compared to other health care. Canada has traditionally spent a smaller proportion of its health-care dollars on mental health and addiction care than other western nations.

If we are to increase this proportion to amounts that match other countries, it must mean reductions or funding changes in other areas. Are we as a population ready to bite that bullet?

Dr. Robert Miller
Head of department of psychiatry
Medical director, Mental Health and Addictions Services
Vancouver Island Health Authority

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