New Horizons: A shared vision for mental health (U.K.)

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To download the entire document (PDF), please click here.

Also see:

Confident Communities, Brighter Futures: A framework for developing well-being (PDF)

Flourishing People, Connected Communities: A framework for developing well-being (PDF)

Realising ambitions: Better employment support for people with a mental health condition (PDF)

Work, Recovery and Inclusion: Employment support for people in contact with secondary care mental health services (PDF)

Mental Health in Scotland

Standing Committee on Public Accounts - Mental Health Services - June 23rd

Standing Committee on Public Accounts

Wednesday, June 23, 2010

Witness/Agenda:

9:00 - 11:00 am

Department of Health

Mr. Kevin McNamara, Deputy Minister

Re: Mental Health Services

To view the video recording of this session, please click here.

Spring 2010: Stigma and discrimination in health care

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To download the entire issue (PDF), please click here.

Recidivism Drops in Those Supervised by Mental Health Courts

An article published in the June 18th edition of Psychiatric News:

By Aaron Levin

Research on the outcomes of mental health courts is steadily accumulating, and the results show promise, but some critical questions remain unanswered.

Criminal defendants who complete programs supervised by mental health courts are less likely to be rearrested in the following two years, according to a new study by North Carolina researchers appearing in the May Psychiatric Services.

About 72 percent of those who completed the program were not rearrested in that time, compared with just 19 percent of those who were expelled from the program and 37 percent of those who chose to leave, said Virginia Hiday, Ph.D., a distinguished professor of sociology and anthropology, and doctoral student Bradley Ray, M.A., both at North Carolina State University.

To read the entire article, please click here.

Also see:

Nova Scotia's Mental Health Court Program

Officer in the Order of Canada

A posting made on June 19th by daylife.com:

Chair of the Mental Health Commission of Canada Michael Kirby is awarded the rank of Officer in the Order of Canada by Canada's Governor General Michaelle Jean at Rideau Hall in Ottawa, June 18, 2010.

Photo credit

John Devlin's Dreams of Cambridge

An article posted today by the BBC:

In the middle of an island in Nova Scotia, Canada, John Devlin has created an idyllic version of Cambridge and Oxford Universities.

But, Canadian-born John [pictured] has not actually built this dream structure. It began as the idea of a damaged mind coping with psychotic episodes.

Therapy came in the form of sketches of the colleges, as a reminder of John's days as a student in Cambridge.

These Dreams of Cambridge are on show until 25 June, 2010 at King's College.

To read the entire article, please click here.

Also see:

John Devlin: Alchemy and Architecture

The Portland (Maine) Identification and Early Referral (PIER) program

Also see:

The Portland Identification and Early Referral (PIER) Program

Center for Psychiatric Research, Maine Medical Center Research Institute

Mental Illness Prevention Finally Gets Support From Science

News from the Lunenburg County Chapter of the SSNS (LCC-SSNS)

Nelson Miguel (left, CMHA Lunenburg/Queens Branch) and Richard Balser (LCC-SSNS) volunteered to host a community booth at the Bridgewater Mall to increase awareness and provide information about mental illness and the possibilities for recovery.

As part of fulfilling its mission, the Lunenburg County Chapter of the SSNS will be hosting a booth at the Bridgewater Mall on a bimonthly basis until December 2010.


A big THANK YOU to all of the businesses who sponsored the LCC-SSNS' Walk The World 2010:


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Review of Mental Health Research (U.K.)

To download the entire publication, please click here.

Also see:

Mental health research is 'incredibly underfunded'

Landmark MRC review of mental health research calls for change

Hospitals told to meet mental health standards

An article posted today by CBC.ca:

Health minister sends letters after AG's report

Nova Scotia's Minister of Health has sent hospitals across the province a reminder about their obligations when it comes to mental health services.

Maureen MacDonald [pictured] has ordered top hospital administrators to comply with seven orders, in a one-page letter sent to all nine of the province's district health authorities.

MacDonald said the directive is a response to criticism levelled against her department in a recent report by the province's auditor general.

"I was surprised when I saw the auditor's report," she said Thursday. "There is no point in having standards if you don't implement and monitor the standards."

Last week, Auditor General Jacques Lapointe released a report that looked at whether Nova Scotians were able to access timely mental health care, no matter where they live in the province.

He said Nova Scotia was failing to meet its standards when treating mental illness, and said there is no plan to fix the situation.

Lapointe also said there was inadequate oversight of the system and no effective monitoring of the standards.

The auditor general's office found that of 538 Nova Scotians who received mental health care in Colchester-Hants counties, the Annapolis Valley and the Capital District Health Authority in Halifax, only 14 per cent of the patients got care that met mental health standards.

MacDonald said the letter — sent by Deputy Minister Kevin McNamara on her behalf — was sent to the CEOs of the health authorities on the same day Lapointe's report was released.


DHAs


"District health authorities are not spending their own money and they're not spending my money, they're spending the public money and they need to be accountable for that," she said.

"I'm accountable for the health care system on the floor of the house of assembly but the district health authorities are accountable to me for how they deliver health care services."

MacDonald said as part of her seven directives, she reminded hospitals they cannot refuse to admit patients simply because they do not live in the district.

"There are no geographic barriers to getting health-care services within the province of Nova Scotia," she said.

The Health Minister said she has not yet heard from any of the health authorities in the week since she issued the directives.

Health authority responds

Peter Croxall, the director of the mental health program in the Capital District Health Authority, said one of the problems is that the standards are vague and hard to measure.

"Full of, really, of too much mental health jargon and not really written in a clear, explicit fashion," he said.

Croxall said statistics show one in five Nova Scotians will develop a mental illness.

That large number makes the issue difficult to address, he said.

"The fact that we only have … four per cent of the health budget, I think you can draw your own conclusions from that," said Croxall.

"I'm not saying that we're doing terribly badly but we certainly could use more resources or a redistribution of resources within health into the mental health area."

Croxall said in his experience, there was nothing to indicate Nova Scotians were getting substandard care, despite the auditor general's findings.

Fatality Inquiry Into the Death of Howard Hyde -- Live Web-Cast and Video Archive

Concluded on June 10th, 2010

Judge Derrick expects to complete her report later this year (2010).

The Schizophrenia Society of Nova Scotia (SSNS) had standing at this inquiry and was represented by a total of five lawyers, all of whom were working on a pro bono basis. The SSNS thanks Blair Mitchell (lead counsel), Angela Byrne, Michele Cleary, Marion Ferguson, and Sharmi Jaggi.

Howard Hyde

Adapted from the Nova Scotia Department of Justice's Howard Hyde website:

Pursuant to the Fatality Investigations Act, S.N.S. 2001 C. 31

Presiding Judge:
The Honourable Judge Anne Derrick of the Nova Scotia Provincial Court

Inquiry Counsel:
Dan MacRury Q.C., Chief Crown Attorney for the Cape Breton Region

To view archived recordings the closing submissions, please click below:

HYDE INQUIRY ARCHIVE

Also see:

Hyde remembered fondly at close of inquiry

The Howard Hyde inquiry wraps up today (audio, mp3)

Restraint technique led to Hyde's death: lawyer

N.S. inquiry counsel recommends foregoing Tasers to restrain mentally ill

No Tasers on mentally ill: lawyer

Inquiry to wrap up in Nova Scotia jail death

Howard Hyde Inquiry

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.

Chronic underfunding

A letter to the editor published in today's edition of The Chronicle Herald:

John McPhee’s worrying page-one article on June 2 refers to the fact that in Nova Scotia only 3.5 per cent of the health budget goes to mental health services. This contrasts sadly with 10 per cent allocated to mental health services in the U.K.

Is it any wonder, therefore, that our mental health services — for adults and the elderly as well as for children and adolescents — are in serious difficulties?

William O. McCormick, psychiatrist, Mental Health Services Bedford/Sackville

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."

Photo credit

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