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.

This is the kind of reporting I think is really valuable - Robert Matas takes a press release from the B.C. government and digs into what it really means, putting in the context for readers so that they can better understand the significance (or lack thereof) of the announcement on more childcare subsidies.

Unbelievable story about the culling of sled dogs in Pemberton.  People are going to go crazy over this one, all over the world. And what a nasty taint to give the B.C. Olympics - the image of all these happy huskies touring Olympic visitors around for their little sled rides, then killed at the end of the season because nobody could be bothered to figure out a better solution.
Nice try with the "we tried to get these dogs adopted" bit, but did you hear a word about this up until now? Had the company come out with a press release saying 100 dogs were going to die unless people stepped forward to adopt them, there'd have been homes found. If we can send hundreds of rabbits to rescue projects in the U.S., surely we could have found placements for retiring sled dogs.
Here's a link to the blogosphere heating up over this one. A measure of just how big this story is going to be: I did a Google search on "sled dogs killed" and quickly pulled up search page after search page of news coverage, blog comment and tweets on the Pemberton dog massacre.
Just in case you're thinking this is some kind of anomaly in the dog-sled-tourism business, a 2005 story out of Denver, Colorado notes a similar shocking slaughter south of the border.

This piece points out some fairly staggering dollar figures for health-care fraud in the U.S. I went looking for made-in Canada stats but can't seem to find any, but I did come across this site that has some news about the kinds of things we get up to on this front in our country.

We don't want police as arbiters of public information

Without question, the murder-suicide in Cadboro Bay last week was a “family tragedy,” in the words of Saanich police.

But it was also a crime, and a very serious one at that.  And yet the police department has refused to release the usual details that are made public after a murder. In the case of Erich and Kathy Mueller, police are even refusing to say who was victim and who was murderer.

I feel for the Mueller family. But then again, I feel for all the families who have to endure a crime, not to mention the media coverage that follows. It must be quite a terrible experience when it’s your child, your parents, your life, being blasted all over that day’s news, and at a time of immense grief.

Unfortunately, that’s how it is in a free country. Someone caught committing a crime, no matter how small, could end up in the news if the media take an interest. If you kill someone, your crime is absolutely going to get coverage.

That’s exactly how it should be in my mind. Police departments are overstepping their bounds when they make arbitrary decisions over how much information to release to the media.

It’s rare for police to withhold basic details, mind you, and from what I can tell happens only when the crime has been committed by an older person from a good background. But that fact just underlines that police are making these kinds of decisions for all the wrong reasons.

If the Mueller murder-suicide had happened in a downtown hotel known for its impoverished, addicted clientele, would police still be withholding the most basic details of the crime - like who killed who? Or if the couple had been, say, Somali immigrants two years in the country? Or a young aboriginal couple?

Of course, it could be that in all of those situations, police would have made exactly the same decisions around what information to release. Maybe factors like economic status, age, family likeability and race don’t play a role in such decisions, and never mind how it looks from the outside.

But at a minimum, police should tell us why they won’t release more details in the Mueller case. Nobody wants to make life any more miserable for the family, but the principle underlying this issue is too important to ignore.

We all recognize police aren’t able to make certain details public immediately after a crime  - in the interest of solving it, notifying next-of-kin and securing public safety.

But that’s not this is about. This is about special status conferred to some families based on the personal feelings of police.

Do we really want police deciding on our behalf which crimes we’ll be told about? Which details we’ll learn? Do we want to leave it to police to pick and choose which families will be shielded from adverse publicity - and conversely, which ones won’t be?

This latest tragedy isn’t an isolated case. I remember a heated exchange over the Times Colonist boardroom table with two Victoria police officers. It was 1994 and I was city editor, and police were very, very angry with us for publishing the names of a local dentist and his wife found dead in their Rockland Avenue home.

The dentist had killed his wife with a hammer and then hanged himself. But police were categorizing it as a “family tragedy” rather than a crime, and had refused to release the couple’s names. They were furious that the paper had gone ahead and reported who they were anyway.

More commonly, police categorize elderly drivers from good backgrounds as “different” for media purposes in cases where the driver ends up killing or injuring people. Their names are virtually never released to the public.

Why? Are we saying that it’s less of a crime to injure someone when you’re old and demented than it is when you’re young and stupid?

I roll my eyes with the best of them at the excesses of the media. But we should all be grateful that somebody’s out there pushing on the public’s behalf. Knowing the details can be painful, but it’s a heck of a lot better than leaving it to police and government to decide what the public has a right to know.

Equal treatment at the hands of the law is a well-entrenched social more in Canada, and a constitutional right. Surely that includes equality and transparency around how police report out on crimes.