IWK cuts waiting list by deleting names

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

1,100 child mental health patients affected

By Selena Ross

What does it take to get off a waiting list?

Of the 1,100 children removed since November from the IWK Health Centre’s waiting list for mental health services — an astonishing statistic the Halifax children’s hospital released widely on Monday — about half weren’t treated, and the hospital removed many of those without directly contacting them.

That’s because the IWK sent a letter to all families on the waiting list in September or October asking them to call back if they still wanted service.

Many didn’t call back. The list was instantly cut back by about half, the vice-president of patient care, Jocelyn Vine [pictured], said Thursday.

Since then, the hospital has screened hundreds of children for the first time, leaving 70 on the waiting list. But on Tuesday, Vine described that overall 94 per cent reduction as a "really very profound improvement in access to care" without explaining that hundreds of names had simply been deleted.

The hospital used the numbers this week to show its success under a reorganization that included the layoff of 22 youth-care workers.

Parents and mental health advocates challenged the math after reading about the hospital’s announcement this week.

"I had a feeling . . . I just wondered what had happened to that 1,030 people," said John Roswell of the Digby Clare Mental Health Volunteers Association.

"If they could see 1,100 people in three months, we could clean up the mental health waiting lists throughout the province in a big hurry."

Roswell said he called Vine on Wednesday to ask how the hospital came up with the numbers, and she explained the mass mail-out.

"I couldn’t believe what she said," he said. "I just thought it was a terrible misrepresentation of the facts.

"I understand their point about improving patient care and decreasing wait times. I mean, that’s all very applaudable, but I think we need to be upfront about it."

The mother of a 10-year-old Dartmouth boy who waited 14 months for a first appointment said she responded to several surveys the hospital mailed out during that time to reaffirm that the family still wanted care.

Last fall, the letter contained a deadline, said Carol Mack, whose son suffers from anxiety-related problems.

"It was something about how they were reorganizing their wait times . . . then you had to call this phone number, which is the Dartmouth clinic, I believe. (It said) if you are still requiring services, you have to call it by this certain date. Otherwise you’ll be removed from the wait list."

As Mack remembers it, she had about a month to call.

"But if they didn’t have the current phone number or address for someone, you were out of luck. Or, say, someone just missed it, you’d be totally kicked off the list."

Vine said Thursday that the hospital made extra efforts to get in touch with families who didn’t respond. Some also phoned to say they no longer needed care, she said.

Those who didn’t speak to the hospital were taken off the list, but they’re free to call and re-add their names any time they want, she said.

"Some chose to call in. Some didn’t," she said. "It’s totally up to them."

The numbers on the waiting list are not misleading, Vine said. Services were offered to all 1,100 families.

"We can only go by the data that we have. It’s a completely accurate number, based on the information that we had. We went back and re-engaged with people. . . . Based on their answer, we’re moving forward accordingly."

The hospital’s overall progress in the mental health unit is not in doubt, Vine said. Since November, the unit has sped up the rate at which it handles new patients and is seeing more children per week than previously.

She said she had no statistics showing that change.

Image credit

Also see:

Wait times too long for some (March 18th)

Mental health care more than hocus-pocus (March 17th)

IWK changes emphasize early intervention (March 15th)

Decision to dispense with 22 youth workers is disgraceful (March 15th)

22 layoffs in IWK mental health program (March 12th)

Mental health treatment for NS teenagers is in crisis! (June 10th, 2010)

Putting the focus back on the patient

An article published in the December 1st edition of The Chronicle Herald:

IWK hopes to whittle down wait for youth mental health services

By John McPhee, Health Reporter

Add value and keep it simple.

It sounds like a business marketing pitch but actually it sums up an increasingly popular system for treating young mental health patients.

Two child psychiatrists from Britain have been working with staff at the IWK Health Centre in Halifax this week to see if the Choice and Partnership Approach will work there.

About 1,100 people are on the waiting list for child and adolescent mental health services at the IWK Health Centre in Halifax. That wait can be as long as 18 months, compared with the standard acceptable wait of about a month.

"They’ve noticed some of their systems haven’t helped users as well as they would like," Steve Kingsbury [pictured], a child and adolescent psychiatrist based in London, said in an interview Tuesday during a break in the training session at a Halifax hotel.

"How you organize services (and) the paperwork you have to do? And I don’t think they could see any way of doing it better until they heard about this."

Kingsbury and Ann York, who also works in London, have taken the "reduce bureaucracy and focus on the patient" message to 11 countries in the past six years. They and other clinicians came up with the system as a way of tackling long wait times and unacceptable outcomes, York said.

"The central premise is how to design services to make things better for the young person and their family, a better experience and more effective for them. All the things we then do organizationally and clinically are around having them at the heart of it."

The usual treatment approach would see a doctor do a thorough assessment of the patient. But recommendations are often made based solely on such assessments, without finding out what makes sense to the family or the child or what they want, the doctors said.

The question of wants, not needs, is crucial to the Choice and Partnership Approach. If the patient is asked what they want, the list is usually short and can be addressed right away by giving the patient and family goals to work on at home.

"They wouldn’t be put on a waiting list for something," York said. "They would go away with an appointment in their hands to see somebody with the right skills to help them with the goals they wanted."

This method has reduced wait times at their London clinics from a year to several weeks. Similar successes have been reported in the countries where they have trained staff and managers. Those countries include the United Kingdom, Australia, New Zealand and Belgium.

York and Kingsbury came to Nova Scotia on the recommendation of a doctor now working in Halifax who underwent the training in New Zealand.

The IWK couldn’t provide an exact cost of the three-day session, but York and Kingsbury said they don’t charge full consultant’s rates. Rather they are paid the equivalent of what they would earn as clinicians in London. It is their first visit to Canada and they combined the working sessions with their vacation.

"It’s not our day job," joked York, who said they continue to work full-time as psychiatrists and devote an average of one day a month to their consultant work.

Sharon Clarke, clinical leader for mental health services at the IWK, said she was impressed by the Choice and Partnership Approach just from reading the material on the website.

"The exciting part for me is that they’re taking a business approach, in the sense of lean thinking, and using these ideas of demand and capacity to really be able to have an accurate assessment of what the needs are in the system — to put people in the right places, to do the right job at the right time."

The IWK will begin using the system in wait list interventions in January and it will be fully implemented by April.

(jmcphee@herald.ca)

Image credit


Also see:

The Choice and Partnership Approach Website

Evaluation Of The Choice And Partnership Approach In Child And Adolescent Mental Health Services In England

Nova Scotia adds addiction services to online wait times list

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

By The Canadian Press

Nova Scotians struggling with addiction can now seek information on how long they might have to wait for help.

The Nova Scotia government has posted information on wait times online for programs including adult community-based services and detox centres.

The government says data will be updated four times a year.

Wait Times

CHOICES Adolescent Services

Community Based Services

Structured Treatment

Withdrawal Management

Also see:

Wait Times for Addiction Services Published

Mental health care for the few

An article posted on March 22nd by MacLeans.ca:

Each year, seven million of us experience mental illness. Many can’t get help.

By Ken Macqueen and Julia Belluz

On March 29, Maclean’s hosts “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the Winspear Centre in Edmonton. The conversation on health care, held in conjunction with the Canadian Medical Association and broadcast by CPAC, continues in coming months in Maclean’s and at town halls in Vancouver and Ottawa.

Mental illness, and what passes for Canadian mental health policy, has been called the “orphan of health care,” and perhaps that’s true. It’s also been called an invisible disease, but that’s not really the case. The mentally ill have many faces. They are in our schools, our homes, our emergency wards. They are in our jails, in our graveyards; they are on our Olympic team.

They are people with names. Jack Windeler, a Queen’s University student of great promise, began to miss classes, skip assignments, withdraw from friends. A year ago on March 27, he killed himself in his residence room. He was 18. BobbyLee Worm [pictured], a deeply troubled 24-year-old Aboriginal woman from Saskatchewan, has spent some three years locked in solitary confinement in a B.C. prison, counting the bricks of her cell. Speed skater and cyclist Clara Hughes overcame a troubled adolescence to compete for Canada at the 1996 Olympics. Afterwards, she fell into a profound depression, slogging “through quicksand and hopelessness.” She sought help. She fought back to become one of Canada’s greatest athletes, and the kind of role model who can shatter stereotypes and stigmas surrounding mental illness.

This, then, is the state of mental health policy in Canada: scattered flashes of brilliance amid quicksand, hopelessness and waste. Canada is the only G7 country without a national mental health strategy, says Louise Bradley, president of the Calgary-based Mental Health Commission of Canada, a four-year-old agency mandated to finally draft a coherent approach to the issue. She blames the shame surrounding mental health issues for the lesser priority and lower funding accorded treatment of psychiatric disorders. Bradley, a nurse and former front-line mental health worker, sees the stigma in the public, but even among health care workers and those with mental illnesses. It’s tragic, she says, since hardly anyone is untouched by the problem. When people discover her job, they always have stories. “Every time it starts out in hushed tones,” she says. “And yet here we are in 2011 still with it shrouded with embarrassment and fear.”

The need is obvious. The annual cost to the economy in lost productivity was pegged at $51 billion in a report last year by researchers at the Centre for Addiction and Mental Health (CAMH). Some seven million Canadians will experience a mental illness this year, including depression, substance abuse and psychotic episodes. Many go undiagnosed, some suffer silently, others self-medicate with drugs or alcohol. They overwhelm family doctors or jam emergency wards ill-suited to their needs. They face long waits for counselling.

“Access to mental health services overall is pretty poor,” says Steve Lurie, executive director of the Canadian Mental Health Association. “In Ontario, basically one in three adults get access. If you’re a child, it’s worse. It’s one in six,” he says. “We wouldn’t accept that for cancer. We wouldn’t accept that for heart [disease] or if you have a broken leg.” Psychiatric care is far more likely to be provided to wealthy adults, says Dr. Michael Rachlis, a Toronto-based health policy consultant. “Children and youth is much harder work,” he says, “and it tends not to pay as well as sitting in your office and seeing people who have less serious problems.”

Many of the needed public services are delivered piecemeal or they fall outside of medicare. Sarah Cannon of St. Catharines, Ont., executive director of Parents for Children’s Mental Health, lost her husband to suicide eight years ago. He suffered from bipolar disorder. Their daughter Emily received a similar diagnosis at age five. Finding quality treatment was a struggle. Emily’s teachers used different treatment strategies from those offered by her community mental health workers. “[There's] a lack of consistency,” she says, “lack of them speaking with each other.” At times, Cannon was spending as much as $800 a month on drugs not covered by Ontario’s health plan. Emily, now 14, is being effectively treated with mood stabilizers, in combination with counselling and occupational therapy. “I want a system that is integrated, that communicates and coordinates,” Cannon says, “that is funded the same way they would fund a system that treats a child with physical health problems.”

Most psychological care, for example, is paid privately, putting it beyond the reach of many. About seven per cent of government health expenditures go to mental health, well below most developed countries.

Suicide is the second leading cause of death for young Canadians. Some, like Jack Windeler, never even seek help. His heartbroken family has launched a youth public awareness campaign, honouring his final wish that others benefit from his story. Bill MacPhee, 48, of Fort Erie, Ont., is alive because he got help, eventually. He was diagnosed with schizophrenia at 24. “After that, I was hospitalized six times, lived in three group homes, had a suicide attempt,” he says.

It was medication and the help of a mentor that got him on track. In 1994, he founded SZ Magazine, for those affected by schizophrenia. As an advocate for those with mental illness, he sees many flaws in the system. Newer, more effective drugs aren’t covered by Ontario’s assistance plan for the disabled, and support systems are uncoordinated, he says. The Ministry of Health operates in one “silo,” the welfare system in another, community housing in another still. Misplaced ideas about patient confidentiality isolate parents. “Many people are being discharged out of hospital without a place to stay, without letting parents know,” he says. “They are trying to help sons and daughters—they’re not able to do that.”

Far too many who need treatment instead end up in jail, often with addictions compounding their mental illness. The number of male federal prisoners receiving drugs for mental illnesses has more than doubled in a decade, to 21 per cent. For women prisoners, the medication rate is an astonishing 46 per cent. The estimate of prisoners with psychiatric disorders ranges from 64 per cent to 81 per cent in one study by the Correctional Service of Canada. Among them is BobbyLee Worm, serving more than six years for robbery and other offences. She arrived at B.C.’s Fraser Valley Institution addicted to drugs and with a history of physical, emotional and sexual abuse. She’s spent years in segregation after repeated fights with prisoners. The isolation has caused “significant signs of psychological deterioration,” claims the British Columbia Civil Liberties Association in a lawsuit filed this month against the federal government.

The news isn’t all grim. There are good strategies in place, though they are often “well-kept secrets,” says Bradley of the mental heath commission. The commission itself is in the midst of an ambitious campaign to reduce the public stigma of mental illness, and aims to release its national mental health strategy by this time next year.

It is likely to build on the success of programs scattered across the country. Saskatchewan has been changing its delivery of services for children and youth, where mental health issues often begin. It includes parent mentoring and “preventive intervention programs” at 16 sites across the province for vulnerable children under five years old, and outreach programs in Aboriginal communities. In Saskatoon, psychologists and counsellors work from inner-city schools. Mental health is part of a larger “school wellness initiative” where speech pathologists, occupational therapists, nurses and counsellors work together. In addition, addiction workers operate in the inner city, says Rob Strom, coordinator for community and youth addiction teams in Saskatoon. “Our workers are out helping our clients get to appointments, get hooked up to the right services, taking them out for lunch or coffee, building relationships.”

Hamilton, meantime, has become a model for breaking barriers between family doctors and mental health services. Counsellors and psychiatrists are integrated into the offices of 150 family doctors in the area, in a program started in 1994, under the guidance of Nick Kates, a psychiatrist and professor at McMaster University. The program is as effective as it should have been obvious. Doctors are usually the first point of contact for those with mental issues, diagnosed or otherwise. Rather than a referral and a long wait, there’s immediate mental health counselling available, says Kates, “in an environment that people find is less stigmatizing and more comfortable.” Doctors in the program refer 11 times as many people for mental health assessments as they did before. Hospitalizations for mental health have dropped 10 per cent for patients of participating doctors, says Kates. The good news is patient-focused care saves money. “The key to successful change is not just throwing more and more resources into the system,” he says. “It’s redesigning the system and using existing resources differently.”

The same optimistic note is sounded by Dr. David Goldbloom, medical adviser for CAMH, and vice-chairman of the mental health commission. While there is a desperate need to improve services, especially for children, he says the issue is finally on the political radar. The cost of mental illness, to individuals and families, and its impact on society and the economy is too massive to ignore, he says. “Both a humanitarian and business argument can be made for doing a better job in this country around the provision of understanding, of help and of hope.”

Also see:

Sask. woman sues over solitary confinement


Photo credit

Mental health beds full up

An article published in the January 5th edition of The Chronicle Herald:

Capital Health faced with ‘unrelenting demand’ for admissions since September

By John McPhee, Health Reporter

Capital Health’s psychiatric care system has been under "almost unrelenting" pressure this fall, the head of psychiatric services said Tuesday.

Every one of the district’s 69 mental health acute care beds has been filled since September.

Ian Slayter [pictured] doesn’t know why there has been such a continuous need for admission.

"Our length of stay has decreased a little bit but we still have a lot of people coming for care," he said. "Any particular week, it’s not more than usual, but we’ve had week after week of almost unrelenting demand for beds."

Those who are waiting for acute care beds are either kept in the emergency department where they were admitted or, more preferably, sent to a psychiatric bed in a nearby health district, Slayter said.

Compounding the problem, patients often stay in psychiatric beds after they’re ready to be discharged. That’s because there’s often nowhere in the community — such as supported apartments or nursing home beds — for them to go, Slayter said.

"It’s like filling up a bathtub. Sooner or later you’re gong to overflow."

A woman who contacted The Chronicle Herald said she was turned away from the Cobequid Community Health Centre’s emergency department this week, even though she was told she needed treatment.

The elderly Beaver Bank woman, who didn’t want to be identified, said she was previously treated and hospitalized for acute anxiety.

"One doctor tried to get me in the hospital (but) another doctor told me that the beds were filled," she said. "We have a desperate problem here."

Slayter couldn’t comment on the woman’s specific case, but said hospitals don’t send anyone home who needs to be admitted.

"If the people assessing the patient feel they need to be in hospital . . . then we will keep them in emergency until we have a bed to send them to," he said.

Psychiatric services has been trying to deal with the shortage of psychiatric beds with several programs, Slayter said.

"We’ve been taking some of the more complex cases and building residential placements for people," he said. "It costs quite a bit of money — it’s a 24-hour support service — but when no one else has been willing to take them, we’ve done that in several cases over the past couple of years."

In another program, 35 to 40 people have been placed in supported apartments, where people live alone but they can call for help any time of the day, he said.

And plans are in the works for a psychiatric intensive care unit at the East Coast Forensics Hospital in Dartmouth. Five to 10 beds will be established in early spring for people at a high risk of harming themselves or others.

(jmcphee@herald.ca)

Auditor General's Report - Mental Health Services in Nova Scotia

An excerpt for the Auditor General’s Statement to the Media today:

A second audit covered in this report was hampered to a lesser extent by the same restrictions on information. The Department of Health, under instruction from the Executive Council Office, refused to provide us information on budget requests related to mental health services.

Treatment of mental illness is a significant part of the health care system. Mental illness accounts for over 15 per cent of the disease burden in developed countries, and for 3.4 per cent of the Nova Scotia health budget.

In 2003, Nova Scotia became the first province to implement mental health service standards. The Department was aware at the time that funding levels were inadequate to achieve these standards.

When the standards were introduced, the Department acknowledged it would take five to ten years to fully achieve compliance with them. Seven years later, our audit found that the mental health service standards were met in only 14 per cent of the cases we tested; and there is no evidence of a plan or funding to close the gap.

The Department of Health has failed to meet its legislated requirement to monitor and evaluate the quality of mental health services. The lack of departmental oversight and monitoring significantly increases the risk that the mental health care system will fail the people who need it most.

The Department of Health has accepted our report and agrees with all 19 recommendations. However, the government has a poor record of implementing our recommendations. I would draw your attention to the next chapter of this report - a follow-up on the 82 recommendations we made in June 2007. To date, the government has implemented just 27 per cent of those recommendations. This is the worst performance since we began tracking government response to our recommendations in 2002.

The Department of Health was the subject of 48 of those recommendations, and accepted all but one. Two years later, 34 recommendations - 71 per cent - were still not implemented.

This is a concern given the nature of the 2007 recommendations, dealing with issues like financial and quality controls in nursing homes and equitable placement of seniors in need of care.

To access the entire Auditor General’s Report, please click here (PDF).


Also see:

Lax oversight of mental health standards, N.S. auditor says

Children waiting for mental health services

An article posted today on CBC.ca:

Children and families are waiting up to a year for a routine referral for mental health services at the IWK Health Centre, a group of Nova Scotia MLAs were told Tuesday.

Senior mental health officials told the community services committee that the health system is struggling to keep up with an ever-growing demand for services.

"We have between 700 and 1,000 children and families waiting. It's a moving target so it changes daily," said Susan Mercer, senior director of mental health and addiction services at the IWK, the children's hospital for the Maritimes.

Mercer said it should take no more than three months to get a regular appointment, but people are now waiting anywhere from six months to a year.

Linda Courey, director of mental health and addictions for the Cape Breton District Health Authority, said early diagnosis and treatment can be key.

"If you can identify these symptoms before the first psychotic episode the major decrease in functioning that these kids will experience over the course of their lives and the subsequent demand on the health-care system, you can prevent that. You can have a massive impact," she said.

But in Cape Breton, as in Halifax, only the sickest get help quickly, Courey added.

More money not the answer

New Democrat MLA Maurice Smith [pictured] found the news alarming.

"I just find it overwhelming," he said. "I'm amazed. It seems to me almost like a crisis kind of situation."

Mercer said there are too few resources to meet the demand. Even with more money, she said, there aren't enough mental-health workers to do the work.

"Everybody is struggling to provide adequate mental-health services across the country," Patricia Murray, director of children's services at the Department of Health, told the MLAs.

The government wants to revamp mental-health services across the province. It plans to name the members of a committee tasked to come up with a strategy in the next few weeks.

Also see:

Staff, money woes plague kids’ mental health care

About IWK mental health and addiction services

Capital District Mental Health Program Community Teams (Outpatient Services): Wait List / Referrals / Wait Times -- July 2009

Please click on the image to expand it.

This and previous months are available by clicking here and using the pull-down menu entitled Mental Health Community Team Wait Times.

Also see:

Patient Satisfaction Survey Results 2007 (PDF)