Fear for kids’ future

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

Re: "A cry from the heart: Save our mental health staff." Kudos to Ally Dawson, the 16-year-old who is gave us the perspective from an (Adolescent Centre for Treatment) client. ACT is a 24 / 7 operation, and is being changed by the IWK to a 24 / 5 operation.

Ally spoke articulately from her heart in support of the program and the youth care workers, whom she has dealt with first-hand.

Why is it that when ever there are budget restraints, it is always the most vulnerable that get affected? Why is it that "top heavy" management is never affected by these decisions, or at the very minimum, equally affected? Although according to a response I received from Premier Darrell Dexter’s office, "there is no budget cut involved with this decision. In fact, mental health services are exempt from the restraint targets in the province’s multi-year plan to get back to balance."

Mr. Dexter [pictured], himself, states "…the design and delivery of mental health services are done by professionals in the field. As you would expect, we fund the DHAs (District Health Authorities) who make the decisions on the best mix of these services, based on knowledge, skill and advice. Over many years, this model has proved successful. I trust and expect that it will continue to do so."

I certainly hope he is right. The public needs an explanation as to what this proven successful model is.

What will this do to the kids in these programs? How many of them will fall through the cracks as a result of this decision? How many youth suicides will we have to deal with, and how many have to land in jail before we realize that this is a mistake?

My heart goes out to Ally and all the clients of the ACT and Compass programs and to the youth care workers who work with them because they love to. It takes special people to do these jobs, and they don’t have to have half a dozen initials after their names to be qualified, professional and do an "amazing" job.

M.L. (Speranza) Anstey, Antigonish

Photo credit

Also see:

Adolescent Centre for Treatment (PDF)

Compass, Centre for Collaborative Child and Family Treatment

The benefits of full time mental health support

Audio clip from the March 22nd edition of the CBC Radio One's (Nova Scotia) Information Morning:

As the IWK changes its mental health care facilities for children and teenagers, we find out how youth care workers and in-patient treatment at the IWK allowed a young man to tackle his anxiety disorder.

Connor MacLellan and his mother Susan say he would not have recovered from his anxiety and depression without the care he received as an in-patient.

To listen, please click here.

Image credit

Also see:

Realigning IWK mental health: ‘This is the right thing to do’

IWK explains why its making cuts to in-patient care for youth with mental illness

Nova Scotia can’t even meet its own ridiculous mental health standards

Assistance with navigating mental health services in the Capital Health district

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

IWK 4 South Inpatient Mental Health Partners in Care Committee Newsletter - May 2011

Please click on the image to magnify it.

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

Province, psychiatrists sign two-year contract

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

Specialists to get $147.99 an hour

By DAVID JACKSON, Provincial Reporter

Halifax-area psychiatrists have reached a new funding deal with the Health Department, one the government hopes will help keep the specialists in Nova Scotia.

The province just signed off on the two-year deal, called an academic funding plan, this month. It will help ensure that doctors are actually getting paid for the hours they work, said Victoria Goldring, director of physician services for the Health Department.

Psychiatrists had complained that they were working a combined 20,000 hours more a year than what the previous contract would pay them for, she said.

Goldring said the new contract focuses on hours of service, for both clinical work and teaching. It says the department will cover 156,000 hours a year, with 80 per cent for clinical work and 20 per cent for teaching, research and administration.

That number of hours is the equivalent of 75 doctors working 40 hours a week for the 52 weeks in a year.

The hourly rate increases to $147.99, a 2.9 per cent increase from $143.78. The ballpark salary for a psychiatrist, depending on whether they’re a full professor and other factors, is about $300,000 [per year], Goldring said.

The deal adds about $3 million to the $20-million budget under the previous interim agreement.

Goldring said the new agreement would cover up to 75 psychiatrists, but they are currently several doctors short of a full complement. They work at the Queen Elizabeth II Health Sciences Centre and the IWK Health Centre and teach at Dalhousie University.

She said recruiting and retaining psychiatrists, who are in demand across the country, was top of mind during contract negotiations. She said the province aimed for the new deal to put psychiatrists’ pay here in the middle of the pack nationally.

"They are now at a more competitive rate compared to their counterparts across the country," Goldring said.

"There are shortages of psychiatrists all across the country, but this will help in providing a bit of stability to their numbers here."

A spokesperson for the psychiatrists could not be reached Friday.

Last November, they had threatened to withhold services from the new mental health court after they said the province missed an Oct. 31 deadline for a new deal.

It wasn’t clear Friday whether they had followed through.

The psychiatrists’ last contract expired in 2007, but there was an interim agreement to 2009. This new deal is effective from April 1, 2009 to March 31, 2011.

(djackson@herald.ca)

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

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

Family had been trying for months to get teen murder suspect psychiatric help

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

By Steve Bruce, Court Reporter

The family of a 17-year-old Middle Sackville boy charged with murdering a woman last Friday had been trying to get him psychiatric help for months, The Chronicle Herald has learned.

They had finally managed to get him an appointment for a psychiatric assessment at the IWK Health Centre in Halifax [pictured] on Monday, sources close to the family said.

But something allegedly went horribly wrong before the boy could be assessed.

Last Friday at about 12:15 p.m., RCMP found the body of Joyann Wright, 49, in her home on Hewer Crescent in Middle Sackville.

Police haven’t released the cause of death, but sources say Wright was stabbed and that the boy tried to kill himself after he fled the scene in her vehicle.

The teenager, whose identity is protected by the Youth Criminal Justice Act, was naked when he was arrested on a Lower Sackville street.

Police believe he was involved in a string of motor vehicle collisions after the killing.

A Saturn Astra owned by the victim crashed into a postal van on Rossing Drive, about 50 metres from Hewer Crescent. The vehicle also crashed into the back of a dump truck that was parked on Millwood Drive.

Then the boy was involved in a minor car-pedestrian accident on Sackville Drive after apparently throwing himself in front of a vehicle.

He received treatment for his physical injuries at the Cobequid Community Health Centre in Lower Sackville before he was transferred to the mental health unit at the IWK.

The boy wasn’t able to make it to Halifax youth court Monday morning from the hospital.

Defence lawyer Stan MacDonald appeared in court on the boy’s behalf.

Judge Pam Williams granted MacDonald’s request to have the matter adjourned until Friday.

The teenager will remain in custody at the IWK.

A Crown attorney will be brought in from Sydney to prosecute the case, court was told.

MacDonald refused to comment on his client’s mental health history when contacted by this newspaper Monday afternoon.

Outside court earlier in the day, the boy’s lawyer said the IWK unit "is the appropriate place for him right now."

"At this point, what I would like to say is to convey that his family is very appreciative of how the police dealt with the matter and very appreciative of the treatment that he received at the Cobequid centre and at the IWK," MacDonald told reporters.

The boy has one conviction for theft. He pleaded guilty in January and is due to be sentenced in April.

(sbruce@herald.ca)

Also see:

System is in chaos, mental health advocates say

Three cheers for outspoken health bureaucrat

Mental Health Advocate (IWK Health Centre)

Mental Health Mobile Crisis Team (PDF)

Photograph of the IWK Health Centre courtesy of the Department of Pediatrics, Faculty of Medicine, Dalhousie University.

Mental health system 'needs help,' funding

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

Programs to help youth are in crisis, even worse for adults, doctors say

By Eva Hoare, Staff Reporter

The mental health system serving Nova Scotia’s young people is in crisis, say health care advocates who are holding a news conference in Halifax today to demand action on the province’s failing mental health program.

On average, three kids per day landed at the IWK Health Centre’s emergency department in 2008 suffering from severe mental health symptoms, and it took six to 12 months for a young person to get an initial consultation with a psychiatrist, a psychiatrist involved in the system said recently.

But those numbers could get worse if something isn’t done to recruit and retain more psychiatrists, the advocates said.

"It’s particularly acute for child psychiatry," said Dr. Aileen Brunet, a consultant to the IWK’s Youth Justice Service.

Dr. Brunet is also a forensic psychiatrist with the East Coast Forensic Hospital and president of the Nova Scotia Psychiatric Association.

About 70 full-time and 20 part-time psychiatrists, who mostly work in the Halifax Regional Municipality under an academic funding agreement with the Health Department, have been working without a contract since April 1, 2008.

Before that they were on "repeated interim agreements" — each a year in length — since 2006, said Dr. Brunet.

She’s worried a proper mental health strategy won’t be developed without a longer-term contract.

"We can’t hire new people, so we can’t reduce wait times," she said.

The picture is even worse for adults suffering from mental illness; their numbers at emergency departments double those of youth, the advocates said.

However, some good news did occur this past week when the psychiatrist group signed a memorandum of understanding with the province and a new deadline for a contract was set for this October, said Dr. Nick Delva [pictured], the head of Dalhousie University’s psychiatry department.

"I think we’d be happy with any current contract," Dr. Delva said in an interview Thursday. "The problem with us is that we’ve had no contract since April 1, 2008. We do need to keep ahead of these things and not get so far behind."

He said it’s imperative that a mental health strategy be developed for the province.

"I think mental health has been underfunded," Dr. Delva said, noting the amount set aside in Nova Scotia is lower than the national average.

More community-based mental health centres are needed. If they existed more mental health care beds could be freed up in hospitals, Dr. Delva added.

"We see a real need for a real recruitment and retention strategy for psychiatrists from the Department of Health," said Wendy Ackerley, director of resource development for Laing House.

The house helps people, aged 16-30, living with mental problems.

"Youth with mental illness have a need for support at times. Those times are very critical," she said, before adding that more systems must be put in place to help young people before they land in emergency rooms.

Andy Cox, who’s on the board of Laing House and the Mental Health Commission of Canada, added his voice to the cries for a provincial mental health strategy.

"One in five Nova Scotians experience mental illness and youth (numbers) are even greater than that," said Mr. Cox. "We have a mental health system that just needs help."

New Brunswick has followed the federal government’s lead, implementing its own plan, said Mr. Cox, also a patient advocate for the IWK’s mental health and addictions department.

A proper plan would include a campaign to destigmatize the illness among Nova Scotia’s youth, emphasizing the need to attract, retain and shorten wait times, he said.

"I would say mental health is in crisis; across the country, but especially youth mental health," Mr. Cox said.

Linda Smith, executive director of Mental Health, Children’s Services and Addiction Treatment for Nova Scotia, acknowledged the amount set aside for mental health is still low; running at about 3.5 per cent of the provincial budget. But she said spending has increased by 63 per cent over the past eight years.

"Is that enough? . . . We would always like to have more," she said in a recent interview.

Wait times are longer "than we would like," she said, but she believes that stems more from a shortage of psychologists and other mental health professionals rather than psychiatrists alone.

Also see:

Politicians’ mental health ideas criticized

Kids wait 1 year for mental health services: IWK CEO

A September 18th posting on CBC.ca:

A backlog of cases has resulted in a year-long wait for some young people seeking mental health help, the head of the children's hospital says.

Anne McGuire [pictured], CEO of the IWK Health Centre in Halifax, spoke at the annual meeting of the IWK on Wednesday.

She said she's not sure why there has been a surge of mental-health cases among children and adolescents, but listed a number of possibilities.

"Whether there's more mental health issues in those age groups, or if we just haven't paid as close attention to them and we perhaps were unable to diagnose as well as identify them," she said.

McGuire said mental health has never received the resources and funding that go into treating physical diseases. To turn things around, she said, the IWK needs to focus more on earlier diagnosis to reduce waiting times and have more outpatient and residential programs.

Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, said children need to be diagnosed as early as possible.

"It's absolutely critical for a number of reasons, one of which is that the person who has the illness is in great distress," he said. "I know because I've personally experienced mental illness at a young age and I know how distressful that was."

Ayer said children and youth who can't get help right away are essentially being kept from living fulfilling lives.

It's ultimately the Nova Scotia government's responsibility to make sure mental health services are given the necessary attention and funding, he said.

To view the IWK's 2008 Report to our Community, click here (PDF).

Photograph of Anne McGuire courtesy of the IWK Health Centre.