MENTAL HEALTH AUDIT

An editorial published in today's edition of The Chronicle Herald:

Slippery standards

NOVA Scotia has long pointed out that it’s the only province in Canada with mental health standards.

And yes, adopting those standards in 2003 was certainly a laudable step towards improving mental health services in this province.

Having standards on paper, however, is one thing. Ensuring they’re being complied with, or, more basically, seeking sufficient funding to do so, is another.

The problem, as Auditor General Jacques Lapointe’s 2010 review of mental health services makes painfully clear, is that the Department of Health seems to have done neither.

Mr. Lapointe was unable to assess whether the department had even asked for the money to meet the standards — an estimated $23.5 million — as the department, following instructions from cabinet officials, denied him access to budgetary requests and possible departmental plans to improve accountability.

This is the same problem that led Mr. Lapointe to criticize the government’s "pervasive policy of secrecy" that prevented him from even auditing Nova Scotia Business Inc. and the Industrial Expansion Fund (IEF).

What the auditor general did uncover, looking at mental health standards and services, showed there’s lots of room for improvement.

The four health authorities audited in depth — Capital Health, Colchester East Hants, Annapolis Valley and IWK Health Centre — met all the standards selected for review in just 14 per cent of 388 files.

Meanwhile, some standards were so poorly written that staff at the DHAs were asking the auditor general’s staff for help in interpreting compliance.

Mr. Lapointe also found no way to compare waiting times for mental health outpatients, the only category tracked, across the province. That meant the department was also unable to do so, he added. Not surprisingly, Mr. Lapointe concluded that mental health patient care could be suffering as a result of these problems.

The Department of Health says a new mental health strategy, along with a plan to address meeting the standards, is to begin this fall.

The auditor general has certainly laid out, in convincing detail, just how this needs to be done.

Official defends mental health service

An article published in today's edition of The Chronicle Herald:

Provincial official says officials know system needs more resources

By John McPhee, Health Reporter

Mental health providers are doing the best they can with limited resources for Nova Scotians, the acting head of mental health services for the province said Thursday.

Faizal Nanji was responding to the auditor general’s report released Wednesday. It highlighted failures to meet standards of mental health care.

Jacques Lapointe [pictured] also criticized the standards for being vague and the fact that a clear monitoring system doesn’t exist.

"We knew these standards were something we’d need to aspire to, and really, that a significant amount of resources — financial, human capital — would be required to help bridge the gap," Nanji said in an interview.

But those resources don’t yet exist, he said.

"That’s our constant battle, to continue to advocate from here for increased funding, to make the case," Nanji said. "We’re at a key juncture."

Nova Scotia is the only province to have mental health standards, which were established in 2003.

Lapointe’s office studied 358 cases in three different health authorities and the IWK Health Centre in Halifax in an attempt to gauge how well those standards are being met. Only 14 per cent of those cases met all of the standards the auditor general selected for testing.

For example, when a doctor refers a patient to mental health care, that referral should be reviewed within one working day. The auditor general’s office looked at 125 cases in the Capital, Annapolis Valley and Colchester East Hants health districts, and at the IWK. Of those referrals, 41 were reviewed in one day.

As well, a patient accepted into the system should be assessed within 10 working days. Out of 54 cases examined in the three districts and at the IWK, only six people were assessed within that time, the auditor general said.

The Capital district health authority, the IWK and the other health districts targeted in the report have accepted the auditor general’s recommendations.

Lapointe was working with information from a year ago, a Capital health district official said Thursday.

Progress has already been made in some areas that were singled out, said Barbara Hall, vice-president of person-centred services.

The district does keep tabs of wait times and how quickly cases are reviewed, Hall said.

"Some of those systems are not the best. There a lot of manual processes, and we have been working on improving that."

The province’s mental health services department will work with each of the province’s nine health authorities to improve care, Nanji said.

On top of the auditor general’s report, an IWK official told MLAs this week that up to 1,000 families are on a year-long waiting list for mental health services.

"We’re doing the best we can to provide a service that’s good, safe and accessible," Nanji said. "But again, we do need more resources in various forms."

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