Friday, February 04, 2011

Mental health left to scramble for crumbs

Depending on who you talk to, psychiatric care in the region for people with chronic and debilitating mental illness is either in frightening disarray or just experiencing a few bumps on the way to a better day.
A number of the doctors who preside over hospital psychiatric care in the region say the cuts of the last two years have had a disastrous impact on people with serious mental illness.
Two of the doctors have already resigned in protest from the health authority’s Department of Psychiatry, and more have threatened to.  Last month, department members in the South Island passed a motion of no confidence in Dr. Robert Miller, medical director of mental health services for the Vancouver Island Health Authority.
But a spokesman for the health authority says the vote against Miller was “completely inappropriate,” and that the issue is really about a small number of psychiatrists resistant to change. The health authority has complete confidence in Miller, says Dr. Bob Burns, VIHA’s executive medical director for population and community health.
VIHA has kept a careful eye on the 200 to 300 people (the opposing sides differ on the numbers, too) left without case managers due to service cuts in the South Island, says Burns.
The gamble was whether people would fall back on emergency services once they lost the case managers who used to co-ordinate their care. That hasn’t happened, he says. “I can only presume they have other supports in the community.” 
The psychiatrists who passed the no-confidence motion beg to differ. “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,” Dr. Andre Masters wrote in a Times Colonist opinion piece last summer.
Who to believe? Ultimately, the fight is over quality of care for two very different groups of people with mental illness. I’d argue that it’s crazy to pit one against the other.
One group lives in the madness and isolation of the streets, bouncing in and out of homelessness and addiction. The other has housing and more outward stability, but still faces all the challenges of a life lived with chronic and severe mental illness.
The smart and humane strategy would be to ensure both groups get the kind of care they need. Just like chronic physical illness, severe mental illness tends to get better if treated and worse if ignored. The best bang for the taxpayer’s buck is effective, consistent care based on people’s needs.
But it just doesn’t work that way in times of scarce resources and government frugality - particularly when the issue is mental health.
It has been the poor cousin of Canada’s health-care system since the beginning. Services for mental health and addiction continue to be the first place governments look for savings, and the last to attract new money.
So when provincial money started flooding into homelessness initiatives a couple years ago - and hallelujah for that - I guess we should have all known that some other part of the system was going to have to pay for it.
And that’s what has happened. The money that used to pay for case managers for people with chronic mental illness now funds four Assertive Community Treatment (ACT) teams on the Island working with street-entrenched people in Greater Victoria and Nanaimo. 
Burns says the ACT model has tremendous potential for reducing hospital-based psychiatric care. VIHA acted on that presumption by closing 10 beds in the Eric Martin psychiatric hospital and eliminating six case managers to help cover the costs of the outreach teams.
Patient care hasn’t suffered, says Burns. The current dispute with psychiatrists boils down to “a small group stuck in the way we’ve always done things.”
Maybe. The multi-disciplinary outreach teams certainly have been a wonderful addition to street-level resources. They’re making a real difference in the lives of some of the most vulnerable, ill people on our Island.
But did those additional services have to come at the cost of another group of extremely ill people who also need the support?
VIHA has apparently concluded it was overserving that population, given that the group’s use of emergency services didn’t immediately increase after they lost their case managers.
I fear we’ve merely unravelled another thread in a historically skimpy safety net. Time will tell, but in the meantime two poorly served populations are left to fight over scraps.

1 comment:

Rob Miller said...

No argument from me Jody but until there comes a time that the public stands up to demand that an equitable proportion of the health care budget must be spent on promoting mental health then the crumbs that we have must be spread equitably across our island and must be spent wisely. Assertive community treatment and other recovery based services have been demonstrated as most effective and efficient treatments, so it should not be surprising that they have attracted funding whilst other services that are less evidence based have had their budgets trimmed.