Tuesday, June 29, 2010

An eye-opening study out of Vancouver that clearly shows how much of B.C.'s homelessness problem is about people with mental illness falling through the massive gaps in the health-care system.

Friday, June 25, 2010

Mental-health cuts take aim at those unable to fight back

Please don’t tell me that the people in charge of services on the Island for people with mental illness really think that it’s us to blame for the sad condition of mental-health services.
Dr. Robert Miller, medical director for mental health and addiction services at Vancouver Island Health Authority, wrote in a letter to the editor last week that the reason mental health and addiction services are inadequate is because the public makes that choice.
Really? I can’t recall a time when the health-care system has ever consulted Canadians around funding decisions of any kind. I take Miller’s point that our country underspends on mental health services, but I don’t remember a public conversation in which we agreed to that.
Miller, who’s also head of psychiatry for VIHA, rightly raises in his letter the fact that Canada spends a smaller proportion of its health-care dollars on mental health and addiction care than other western nations. Just eight per cent of the health-care budget for Vancouver Island goes to mental health and addiction services. Countries like Australia and the United Kingdom are spending 12-15 per cent.
We did elect the governments who have brought us to this point, it’s true. Maybe that’s what Miller means. But I can’t recall an election when any of the major political parties even put forward a platform around mental health services, let alone worked it as an election issue.
I suppose we taxpayers do deserve the blame for tolerating political parties that can’t even be bothered to talk about mental health. But it’s a pretty big stretch to translate that as meaning the public has made a choice to deny better care to those with mental illness. (Or that we’d ever want public opinion to dictate something as important as who gets good health care.)
And we couldn’t be party to any of the decision-making around health care even if we wanted to. VIHA and B.C.’s other four health authorities have no public accountability, or meaningful public access to their meetings.
Miller’s June 19 letter was the latest in a trio of missives that have appeared in the paper over the past month from doctors and directors at VIHA.
The first letter - from outgoing VIHA mental-health director Alan Campbell - was prompted by a Times Colonist editorial June 9 headlined “A terrible failure on mental illness,” written after the tragic stabbing death of 15-year-old Justin Wendland. Campbell wrote that the health authority had for the last three years increased funding for mental health and addiction services by $6 million a year in Greater Victoria.
His letter brought a shot across the bow from Dr. Andre Masters, a psychiatrist and outspoken critic of cuts to mental health services. Masters took considerable exception to Campbell’s assertion that spending was up.
Then came Miller’s letter, which seemed to be an attempt to make peace between the two sides by shifting the blame for cuts off of VIHA and onto the public.
I’m not buying it. This has nothing to do with the public making a choice. It’s all about the health authority looking for savings in the same old places, and a budget so tight that improving wretched services on one part of the Island can only be done by taking valued services away somewhere else.
Mental-health services are chronically underfunded and the first to be cut because governments know they can get away with it. For all kinds of reasons, mental illness has never had the political cachet and sophisticated lobby of physical illnesses, and was deliberately segregated from the rest of the Canada’s health-care system from the start.
Mental illness can’t be “cured” in that nice, clean way that we prefer, like a broken leg or an ailing heart. Even diagnosing it can be tricky, and the results of treatment unpredictable.
It’s stigmatized and poorly understood. It generates just enough scary media stories of unexpected violence to leave the public with the gross misconception that to be mentally ill is to be dangerous and out of control.
Mental illness knocks the wind out of the best of families in no time flat. Even friends and family members tend to take a step back when the diagnosis is mental illness, instead of stepping up to help the way they would have had the diagnosis been breast cancer or hip surgery.
So when cuts come, they hit a group of people that already feels ashamed, hopeless and unworthy. The axe falls, and nobody has the strength to scream.
Who’s to blame? The decision-makers who take advantage of that helplessness to reduce care to people too broken to fight back.

Wednesday, June 23, 2010

I've been hearing from lots of concerned family members around B.C. responding to my June 11 column on the major changes afoot for British Columbians with developmental disabilities.

The push is on for an end to the group-home model for people with mental handicaps, a change that pleases the families who like the idea of a more independent living situation for their loved ones, but terrifies those who have had bad experiences with private homes (increased isolation, more risk of abuse going undetected, less stable as a "permanent" housing solution, etc).

It seems like a good time to post the
United Nations Convention on the Rights of the Disabled. Take a look at Article 3, which notes that giving people the right to choose what happens to them is a basic principle in the Convention.

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

Saturday, June 12, 2010

B.C. families need to fight for group homes

I remember the exact moment I started to look at people with mental handicaps in a completely different way.
It was 1985, not long after the province had closed the huge institution for “retarded” people at Tranquille, an old tuberculosis sanatorium outside Kamloops. I was working at a Kamloops newspaper at the time and the closure was big news, so I’d been part of documenting the hope, fear, anger and anticipation that the closure had sparked.
Families had been working for long, long lifetimes by then to move things forward for their mentally handicapped children, who were all ages. They had few choices in those years when it came to finding services or schooling for their children in their own home towns, and often had no option but to send their children hundreds of kilometres away to institutions such as Tranquille, Woodlands and Glendale.
The families were mostly over the moon at the thought that Tranquille’s closure would allow them to bring their children home to get all the support they needed in their own communities, which is what the government was promising. But they were terrified, too, because it’s very hard to give up a sure thing for a promise when it’s your child’s life at stake.
As for how I felt personally about the closure of Tranquille - well, I hadn’t really wondered to ask myself about that.
But then came the day when I happened to be stopped on a Kamloops street waiting for a young mentally handicapped boy to cross at the crosswalk. He appeared to be on his way home from school, walking along in the sunshine with a schoolmate and swinging his lunch kit in that big-armed way that every kid in the world is probably familiar with.
And it was all so normal. A 30-second scene, yet it clarified for me in an instant why we had to put the days of giant institutions behind us. Normal is a pretty nice place to be.
All these years on, much has changed for people with mental handicaps. They have the right to go to school. To live a real life in a real community, near to friends and family. To be paid a fair wage for a job well done. To have some say over their own lives. Those are meaningful achievements.
As for the families - well, let’s just say it’s been an interesting 25 years.
Their children’s basic needs haven’t changed in that time, because a mental handicap is forever. But everything about the way the government operates its services has been in a near-constant state of flux. Sometimes that was due to shifting philosophies or new research, but more often it was because somebody in government thought there were savings to be had by doing things differently.
The language changed: mental handicaps became developmental disabilities, and the associations and programs serving that population took to referring to their services as “community living.” When the government created Community Living BC in 2005, a new governance authority that would give families more say over services, many of those families felt they were realizing a dream.
But it’s the year of broken dreams. CLBC is now preparing to shut down group homes - the four- and five-bedroom staffed homes that people were moved into after the institutions closed. The move has been portrayed as being about choice for families, but it’s mostly about saving $22 million a year.
Many families have lobbied hard to give their adult children more housing options beyond just moving into a group home. Independent living is one more step toward normal, and I’m all for it, too.
But everything changes when the primary goal is cost savings. If families aren’t yet alarmed by what they’re hearing from CLBC, they might want to ponder what it would really mean to eliminate the only designated housing supports in B.C. for people with developmental disabilities.
Once all the group homes are gone, families will be left to fight it out with everybody else for low-income housing for their adult children. The support to help people find and keep housing will be there initially, because government needs to make the changes palatable. But for how long? And then what?
This government in particular has a history of being deceptive, ruthlessly ideological and dangerously ill-informed around social spending. CLBC may have honourable intentions, but it’s a good soldier. It’s no more likely than the health authorities to challenge government demands for cuts.
Families, you’ve been here before. It’s wrong that they’re coming for you again, but so it goes in this often unjust world. Fight.

Friday, June 04, 2010

Lessons from BP tragedy: Trust is not an option

As barrel after barrel of oil pours into the Gulf of Mexico, poisoning every living creature that comes in contact with it, I feel again a creeping dread at how little we know about the things we say yes to.
I know almost nothing about deep-sea oil drilling. And I see now that I have made a terrible error in not knowing more, because one of the greatest environmental disasters of our time is unfolding and all I can do is stand here bewildered at how this can possibly be happening.
As with all things I don’t know enough about, I just thought somebody was taking care of things. I thought people with a lot more smarts than me were considering everything carefully and proceeding with the utmost caution, because it’s in nobody’s interest to kill off our oceans.
I presumed - and isn’t that just the saddest word? - that a company drilling an oil well reaching 17,000 feet below the surface of the ocean would have had a backup plan for every eventuality. And that certainly would have included what to do in the event of an explosion tearing the drilling equipment away from the underwater wellhead, as happened April 20 in the gulf.
We know the horrible truth of that all too well now. But it’s just a little late. As always, we are learning the hard way what we never thought to wonder about up until things suddenly blew up.
In the case of the oil spill, perhaps the most disturbing revelation is that neither the company nor any of the regulatory bodies has any idea of how to cap the ruptured well.
Think about that. BP Global has been spending $1 million a day for the last nine years to drill for what it hopes will be three billion barrels of oil deep in the sea, but it doesn’t have a workable contingency plan for capping the hole it has made in the ocean floor. It’s working in water more than a kilometre and a half deep to drill a well that will reach a further four kilometres into the seabed, but it had no tested strategy for turning that massive gusher off in the event of equipment failure.
BP spokesmen are now saying it will probably be August before it gets the spill under control.
In the meantime, the oil pours into the gulf, at a rate of 5,000 barrels a day. An estimated 80 to 170 million litres of oil have poured into the gulf to date, dwarfing the 42 million litres spilled in the Valdez accident. By August, the gulf will be awash in 10 times the amount of oil spilled by the Valdez, and that’s presuming that BP is even successful in stopping it then.
How could this have happened? Point the finger in a dozen different directions. Like the sub-prime mortgage crisis that has ended up devastating the world economy, there are many reasons why.
The U.S. pundits and bloggers paint a picture of a compromised federal government, and an industry used to getting its own way. The inspection process was obviously flawed as well, seeing as the Deepwater Horizon passed every one of its monthly safety inspections this year right up until it blew up in April.
What’s scary about both the mortgage crisis and the oil spill is that they were years in the making, yet no one behind all the fateful policy decisions and bad choices foresaw the disaster being wrought.
Until hundreds of thousands of Americans started losing their homes in the sub-prime mortgage crisis, we all thought somebody was tending to things like that. Until it exploded, the oil rig Deepwater Horizon barely got a mention in the U.S. press, and the world slept well at night in the naive belief that somebody would know what to do were the worst to happen.
We know better now. But what’s to be done about it?
One thing seems obvious: No more presuming that anyone has your back. If you want your children and grandchildren to enjoy a lifetime on this Earth that’s at least as good as the one you’re having, let go of the comforting fallacy that government is tending to all the big stuff.
A rich country. Thousands of brilliant minds. A thick stack of long-standing environmental regulations. And none of it can stop the oil pouring into the Gulf of Mexico.
That’s a lesson we can’t let ourselves forget.

Link to the live feed from one of the remote operating vehicles near the wellhead.