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

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)

Yarmouth area attracts MDs

An article published in the January 3rd edition of The Chronicle Herald:

By Brian Medel, Yarmouth Bureau

YARMOUTH — Several physicians, including a number of psychiatrists, began practising in southwestern Nova Scotia during the summer and fall of 2011.

Three psychiatrists joined Southwest Health recently, bringing the number of psychiatrists to six in Nova Scotia’s westernmost health district.

All psychiatrist vacancies for the district are filled for the first time in more than 10 years, Southwest Health said in a news release.

Dr. Olufemi Banjo came in August, followed by Dr. Razi Hemani in September and Dr. Lourdes Soto-Moreno (pictured) in October.

"It certainly is good news, and hopefully we’ll hold on to them; there’s certainly the need," said John Roswell, a Digby Clare Mental Health Volunteers co-ordinator, on Sunday.

"It’s terrific if we have the full complement. Hopefully, it will mean that people get to see a psychiatrist and eliminate the lengthy wait process.

"It has been practically impossible to get to see a psychiatrist within six months, and it’s very heartening to hope that wait times may be decreased somewhat because of this."

The common wisdom is that 20 per cent of people will require psychiatric services or will experience a mental illness at some point during their lifetime, said Roswell.

The reporting of mental illness and the number of people seeking help has increased, he said.

Dr. Faten Germanus began working at a family medical practice in Barrington Passage in December. She is not yet accepting patients but an announcement will be made soon when she is ready to take on new patients, according to a news release.

Dr. Navdeep Mangat also began working in Digby General Hospital’s emergency department in December and will provide services at the Digby Well Womens Clinic starting this month.

And southwestern Nova Scotia residents with no family doctor but who have high blood pressure may take advantage of a new cardiovascular program at Yarmouth Regional Hospital, to be based in the facility’s wellness centre.

(bmedel@herald.ca)

Photo credit

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

Mental Illness Awareness Week: opening Canadians’ eyes

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

By Stephen Ayer (pictured)

Mental Illness Awareness Week, Oct. 2-8, is an annual national public education campaign designed to help open the eyes of Canadians to the reality of mental illness. The week was established in 1992 by the Canadian Psychiatric Association. It is now co-ordinated by the Canadian Alliance on Mental Illness and Mental Health in co-operation with its member organizations, including the Schizophrenia Society of Canada, as well many other supporters across Canada.

As a kick-off event for the week, the Schizophrenia Society of Nova Scotia (SSNS) presented a special screening last Sunday of the movie The Soloist, based on the true story of Nathaniel Ayers, a musician who develops schizophrenia and becomes homeless. The screenplay by Susannah Grant is based on the book The Soloist by Steve Lopez, a columnist for The Los Angeles Times.

The same day, the society also highlighted the recovery journey of Laura Burke, a young Nova Scotian who lives with schizophrenia, by screening Superhero — A Visual Poem, a documentary short film featuring Ms. Burke’s spoken word poetry. Ms. Burke was honoured during Mental Illness Awareness Week in Ottawa last year as a 2010 Champion of Mental Health.

Today, the Schizophrenia Society of Nova Scotia is partnering with other local mental health organizations and supporters to present the Fourth Annual Festival of Hope, a celebration of hope, healing and recovery. This free event takes place from 3 to 8 p.m. at the Olympic Hall, 2304 Hunter St. (corner of Cunard and Windsor in Halifax).

The core belief of the SSNS is that people with mental illnesses such as schizophrenia can live a life of meaning and purpose. The society’s focus is to promote the goal that each individual will be able to return to a quality of life which meets each person’s own perception of needs and expectations.

The vision of the SSNS is to reach all Nova Scotians who are directly or indirectly affected by schizophrenia — to focus on the individual, not the illness, to promote wellness and recovery, and to reduce the stigma and discrimination so often associated with mental illness.

The society’s mission is to improve the quality of life for those affected by schizophrenia through education, support programs, influencing public policy, and supporting research. The SSNS provides a community-based network of knowledgeable and dedicated volunteers whose personal experience with the illness allows them to share their stories of hope and recovery with people affected by schizophrenia for the first time.

Stephen Ayer is executive director of the Schizophrenia Society of Nova Scotia. He lives with a mental illness and experienced homelessness in the 1990s. Dr. Ayer is a 2009 recipient of an Inspiring Lives Award from the Mental Health Foundation of Nova Scotia and the CMHA — Nova Scotia Division.

Photograph by Ryan Taplin / Metro Halifax

Capital Health changes guards

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

Paladin to take over from RMAC, commissionaires

By Brian Medel

Most Capital Health hospitals will be protected by a new security company beginning Oct. 1.

Paladin Security, Canada’s largest supplier of health facility security, will begin a five-year contract that will cost Capital Health more than $18 million, paying out $3.63 million annually, said a recent notice to staff.

Capital Health now pays about $3 million annually for security, spokesman Peter Graham said Thursday.

The existing contract with two suppliers, RMAC Security and the Nova Scotia division of the Canadian Corps of Commissionaires, will expire Sept. 30.

"We did go out with a (request for proposals) earlier this year," said Graham.

The existing security providers did submitted bids.

"Neither of them were successful," said Graham.

The memo to staff said "RMAC Security and the Corps of Commissionaires have provided us with quality service, for which we are very grateful."

The current security providers will be on the job until midnight Sept. 30, when Paladin Security will take over.

About 100 security officers, 78 of whom are commissionaires, work in Capital Health buildings.

Security staff employed by either the Corps of Commissionaires or RMAC Security will be given opportunity to apply for positions with Paladin, with interviewing and hiring expected to begin almost immediately, said the memo.

The job search website now-hiring.ca said Paladin Security held a job fair in Halifax over two days last week at the Lord Nelson Hotel & Suites, where the company recruited health-care security officers.

Paladin recently opened an office on Spring Garden Road in Halifax.

Two hospital departments that have special security needs are the mental health and emergency units.

Paladin managers will meet with staff from the emergency and mental health departments to ensure the transition is smooth. All Paladin staff receive training that enable them to work in mental health and emergency settings, said the memo.

Health-care security is different from all other types, often involving aggressive patient behaviour, said Leo Knight, chief operations officer with Paladin Security.

"We’re about halfway through our (hiring) process, so we’re probably looking for another 50 to 60 people," Knight said Thursday from Vancouver.

"We got into the Nova Scotia market by doing an acquisition of a local company. . . . Reliant (Security Services)."

It was not a requirement to work here, he said.

"We were coming to the Nova Scotia market anyway. We’re the largest full-service security provider in Canada and we’re the fourth-largest guard company in the country.

"We’re the largest provider of health-care security in the country."

Paladin provides security for every hospital in Alberta and many in British Columbia and Ontario, he said.

Col. Mike Brownlow, chief executive officer of the Nova Scotia division of the corps, said the organization has provided security at Halifax hospitals for many years.

"We’re extremely disappointed, as you can imagine," Brownlow said about not being retained.

"Our relationship has always been a very positive one,"

He said the corps was always concerned with the safety of staff, patients and visitors.

The corps must now look for alternate employment for the 78 veterans hired to work at Capital Health, Brownlow said.

Most commissionaires are military veterans, with some coming from RCMP and municipal police force backgrounds.

Of the 1,700 commissionaires in Nova Scotia, 1,200 are in the Halifax area.

"We’re presently engaging in getting them all placed in different locations," said Brownlow. "There’s a number of them that are retiring.

"Our main mandate is to get employment for veterans."

(bmedel@herald.ca)

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Government cuts hurt people with disabilities

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

By Wayne MacNaughton [pictured]

Last week, the government announced that it was "clarifying" the rules around "special needs" for people living in poverty (re: "Social assistance won’t cover pot," Aug. 10). However, the news coverage thus far has failed to explain the scope and severity of the government cuts that have occurred, and the fact that they will hurt people living with disabilities, on fixed incomes, who cannot afford to pay for their own medical needs.

Far from simply "clarifying" the previous law, the amendments significantly reduce government assistance for essential health needs. In addition, people will be subject to a cookie-cutter approach: If their need does not fall within a pre-existing list, it will not be considered, no matter how essential for health or necessary to alleviate pain and suffering. The government cuts were made without notice, public consultation or input from health or disability rights groups.

The cutback on special needs will have a number of repercussions. On an individual basis, it will undermine people’s health, and increase pain and suffering. This is not good for society, but in addition it will increase the social burden on the health care system, as people struggle with poorly managed medical conditions and illnesses without access to the services they need.

People who had no other alternatives, who had a recommendation from their doctor and needed medication or other services to alleviate pain and suffering, or because it was essential to their health, could apply for "special needs" assistance. As a result of government amendments to the law, that access to those medications and services is now no longer available.

The Department of Community Services has suggested the cuts won’t have a big impact. But ask any person with disabilities who needs to pay higher rent to obtain allergen-free housing, or needs to meet the cost of the only medication that works but isn’t on the list of approved medications, or needs access to counselling for post-traumatic stress, and they will tell you these needs are essential, not frills.

Let’s look at the single biggest justification the government relies on in making these cuts: medical marijuana. Medical marijuana is prescribed by doctors for pain management. Patients who are permitted to use medical marijuana do so on a doctor’s recommendation, under a licence from Health Canada, where no other method or drug for pain management has worked. In denying access to medical marijuana, the government forces people back to reliance on Dilaudid and Oxycontin, drugs that have many more side effects and fewer positive individual outcomes, and have been the subject of inquiries and concerns regarding social costs and addictions. Big Pharma wins, and people with disabilities lose and the rest of us see Pharmacare costs escalate.

Don’t believe the government’s portrayal of "special needs" requests as frivolous wastes of taxpayers’ money. Under the previous regulations, needs that are "essential to health" and "necessary to alleviate pain and suffering" were recognized as "special" and people living in poverty were forced to meet a stringent test to qualify for assistance. These were needs that many of us take for granted because they are essential for health. (In an era when people are trying to decide whether to buy an iPhone 5 when they come out this fall, recipients of social assistance are not even given funding to have a basic telephone in order to look for a job.)

Why is the government cutting back on essential health services for people with disabilities? Figures cited by Community Services in a media release identify only 20 to 25 cases. The release fails to provide comparison figures for increases to other, already listed special needs and Pharmacare (formulary costs), or what we can expect in increased costs to the Pharmacare program and other health services as a result of these cutbacks. The auditor general’s report cited in the release criticizes government accounting procedures, but makes no recommendations concerning the merit of the requests and cannot be interpreted to justify these cutbacks.

Special needs assistance must be restored. When the law was introduced in 2001, special needs for people with disabilities was described as the "cornerstone" of the program. That cornerstone needs to be rebuilt, and fast, to avoid pain and suffering and protect the right to health of all Nova Scotians — including those living with disabilities.

Wayne MacNaughton is an anti-poverty activist living in Halifax.

Photo credit

Also see:

Critics slam changes to special-needs funding

Clear, Consistent Access to Special Needs Funding for People on Income Assistance

Welfare Rights Guide

Income Assistance and Nutrition: Are You Getting What You Need?

Trailblazing on Tasers

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

THREE years ago, a mentally ill man died in custody 30 hours after being Tasered at an HRM police station. Howard Hyde’s heart stopped and he [pictured] had to be revived. The subsequent inquiry determined that it was a restraint hold — properly applied a day later by correctional officers — which caused his heart to stop forever.

Mr. Hyde’s death could have been avoided if he had been handled differently at every turn. Many Nova Scotians still suspect the Tasering was a contributing factor.

Ironically, they might be surprised to hear that many Quebecers were left wondering last week why Montreal police didn’t Taser a mentally ill man who allegedly charged them with a knife. Tragically, the suspect was shot dead instead, and an innocent bystander was killed in the crossfire.

We do not yet know the answers to these questions. If the officers believed they were in immediate, mortal danger, they would not have reached for a (generally) non-lethal weapon. Most likely, they were not armed with Tasers anyway — the Montreal force only has 42 stun guns on hand, compared to Toronto’s 700.

The use of Tasers, especially on emotionally disturbed people, is an emotional issue. But last week, Nova Scotia contributed something useful to the debate: the voice of reason.

In becoming the first province to clarify the rules of engagement in such circumstances, Justice Minister Ross Landry has found the right balance and created a model for other jurisdictions to follow.

We agree with Nova Scotia’s new guidelines that law enforcement officers should consider whether an agitated person is mentally ill and do everything in their power to de-escalate a confrontation, before deploying a stun gun.

We further agree with the precaution — although it’s not always practical — of calling paramedics to the scene before making the call to Taser a medically precarious or disturbed individual.

Most important, police as well as correctional and sheriff’s officers in Nova Scotia will be better trained to recognize signs of a mental illness.

The Hyde inquiry made the salient point that the jail guards didn’t know how to de-escalate confrontations. Better training is certainly the key to enforcing this province’s policy of minimizing harm to the mentally ill.

(edits@herald.ca)

Also see:

Nova Scotia Guidelines on Conducted Energy Weapons (CEWs)

New guidelines a positive step

Taser rules coming

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

By The Canadian Press

New provincial guidelines on the use of Tasers by police in Nova Scotia have been approved and will be released soon, Justice Minister Ross Landry [pictured] said Thursday.

Three weeks ago, in response to an inquiry report into the death of a mentally ill Halifax man, Landry said the guidelines would be released within two weeks.

He now says he has reviewed and signed off on the guidelines and expects they will be made public within the next week or so.

Landry declined to say whether the rules would restrict Taser use against mentally ill people, but added that they would not be a major departure from national standards.

"We’re in line with the overall federal position," said Landry. "I think there are a couple of areas that we’ve probably tightened up ... and I believe it will meet our needs at this time."

The issue is a contentious one because the inquiry into the death of Howard Hyde recommended that Tasers not be used on emotionally disturbed people unless all attempts at de-escalation have failed.

Hyde died in November 2007 at a Halifax jail, 30 hours after police had Tasered him multiple times during a psychotic episode. But the inquiry concluded the Tasering did not cause his death.

Federal guidelines say the use of stun guns should be avoided where possible on women known to be pregnant, the elderly, young children and visibly frail people. The rules also say that the weapons should not be used on a restrained subject or on a person in control of a moving vehicle.

There are no references to mental illness in the national rules, but Landry said it would be addressed in Nova Scotia’s guidelines. He didn’t elaborate.

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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 strategy still seems elusive

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

By Marilla Stephenson (pictured)

What’s the difference between "excited delirium" and "autonomic hyperarousal state?"

Not much. In fact, in the provincial government’s response to the Hyde Inquiry report, the second term is used as a replacement for the first.

The inquiry, headed last year by provincial court Judge Anne Derrick, studied the death of Howard Hyde, a Dartmouth man who died in custody in 2007 at the Central Nova Scotia Correctional Facility in Dartmouth. Hyde suffered from mental illness and the cause of his death was initially identified by a coroner as "excited delirium."

Derrick rejected that as a "red herring." She found that Hyde died as a result of a restraint technique used on him by guards during a struggle.

Hyde had been repeatedly shocked with a stun gun during his 30 hours in custody. Derrick found that while the use of the stun gun did not cause Hyde’s death, the repeated shocks contributed to his deteriorating mental state.

Derrick’s report also strongly called for improved training for law enforcement officers who come in contact with people suffering from mental illness. The judge painted a clear path towards the use of de-escalation techniques in advance of the use of stun guns.

But the province seems to be struggling to find the right balance between public safety issues and the use of stun guns by officers. It has yet to finalize its guidelines for stun gun use, though Justice Minister Ross Landry said Thursday they will be released within a few weeks.

The minister did not explain why there has been a delay in issuing the guidelines or why, if only a few more weeks were needed, the province’s response to the inquiry report was not delayed so the documents could be released together.

But it speaks volumes that the use of the stun guns has already dropped by over 70 per cent since Hyde’s death in 2007, as The Canadian Press reported on Thursday.

In addressing what is now being described as an "autonomic hyperarousal state," the report released Thursday did not rule out using a stun gun on a person who may be mentally ill. But plenty of work remains to be done on the training side of the equation.

"Law enforcement officers must have appropriate tools to assist them in maintaining public safety," says the report. "At the same time, people living with mental illness may already be experiencing a high level of anxiety and the use of restraint could escalate the situation.

"The province and policing partners agree that the use of conducted energy weapons should only occur when a person’s behaviour is aggressive or violent and could harm the person or the public or the police officer. Additional direction is required regarding the restraint of individuals with mental illness."

The delay in providing that direction is not explained but Landry is clearly not comfortable with the current level of knowledge and training.

"It’s very difficult in situations where . . . there’s a high level of disturbance for the police officer to determine whether the person is suffering from mental illness," the minister told reporters on Thursday after the response was released.

In fairness to police, officers are often called on to make very quick decisions about the use of force in highly charged situations. But the death of Howard Hyde, among other cases, provides a reminder of the responsibilities that accompany the use of force, including the use of stun guns and other various forms of restraint.

There are federal guidelines available to help officers make those judgment calls and the province has said its stun gun rules will consider the federal document as well as expert advice provided by a panel of psychiatrists.

Derrick was clearly on the right track in emphasizing the need for much better levels of training. And in fairness to the province, some progress has already been made in addressing areas of concern raised in the inquiry report.

But the wheels continue to grind slowly towards the judge’s most important recommendation, adopting a provincial mental health strategy. The government is still waiting for a report from stakeholders.

It has been nearly two years since the NDP formed government and promises to improve mental health policies and services are growing stale.

(mstephenson@herald.ca)

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Taser guidelines still in works

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

Justice minister promises rules resulting from Hyde inquiry will be released soon

By Michael MacDonald, The Canadian Press

More than three years after the jail cell death of a mentally ill man, the province’s Justice Department has yet to introduce new guidelines describing when peace officers can use Tasers.

Howard Hyde died on Nov. 22, 2007, after a struggle with guards at a Halifax-area jail. His tragic story attracted national attention because Halifax police Tasered him multiple times during a psychotic episode about 30 hours before he died.

In December of last year, provincial court Judge Anne Derrick released a fatality inquiry report that concluded the Tasering did not cause the death of the 45-year-old musician, who had long suffered from schizophrenia.

However, Derrick did find that the Tasering worsened Hyde’s rapidly deteriorating mental state, and she recommended that stun guns should not be used to immobilize emotionally disturbed people unless crisis intervention techniques have failed.

In its formal response to Derrick’s report, the provincial government said Thursday its revamped guidelines are still being finalized.

Justice Minister Ross Landry [pictured] said he is still concerned about the ability of police officers to recognize mentally ill people in distress.

"It’s very difficult in situations where . . . there’s a high level of disturbance for the police officer to determine whether the person is suffering from mental illness," Landry, a former RCMP officer, told a news conference.

Landry said he had hoped to have the guidelines ready before the government issued its response to Derrick’s inquiry. He didn’t say why there was a delay, but he confirmed the new rules will be released within two weeks.

During Derrick’s fatality inquiry, which lasted 11 months, Halifax Regional Police argued that its officers are trained not to stun anyone until de-escalation techniques have been tried. But Derrick rejected that position, saying police policy and the province’s standards made no mention of this requirement.

Despite the absence of new guidelines, the government’s response indicates police have already changed the way they use so-called conducted energy weapons.

Since 2007, the year Hyde died, police use of the type of stun gun used on the man has dropped by 74 per cent in Nova Scotia.

Landry said the dramatic decline was the result of a growing body of knowledge about the weapon. He said police were still learning about the impact of the weapon in 2007 when a medical examiner declared Hyde’s death was caused by a condition known as excited delirium.

The condition, also known as autonomic hyperarousal, is characterized by increased strength, paranoia and suddenly violent behaviour marked by profuse sweating and an elevated heart rate. Hyde demonstrated most of the traits in the hours before he died.

However, Derrick’s report rejected excited delirium as the cause of death, finding instead the death was caused by Hyde’s struggle with jail guards. The judge concluded the guards applied restraint techniques that may have interfered with Hyde’s breathing.

Kevin MacDonald, the lawyer representing Hyde’s sister, Joanna Blair, said his client was troubled by the fact that the government’s response says that police and corrections officials require a clear understanding of how conducted energy weapons may affect people in an autonomic hyperarousal state.

"There appears to be a suggestion that the police be trained to recognize the symptoms of (excited delirium) when . . . judge Derrick’s report states that the province should not emphasize in its policies or training the phenomenon of excited delirium," MacDonald said in an interview.

"It’s significant because excited delirium . . . can be used as a justification for the use of force, which is what happened in Mr. Hyde’s case. I think it’s wrong that they’re taking this position. It’s contrary to what judge Derrick found, and it indicates there’s not an acceptance of the cause of the death."

In her inquiry report, Derrick said she agreed with one expert who testified that citing excited delirium as a cause of death resulted in Hyde being "identified as the culprit."

"(Derrick) specifically cautioned police officers . . . from looking for signs of excited delirium," MacDonald said. "And here is the province suggesting they’re going to train them in recognizing it."

Most of Derrick’s 80 recommendations called for improved training, more funding for mental health services and better co-ordination and communication between justice and health officials.

On Thursday, Health Minister Maureen MacDonald said the province has already implemented some of the judge’s recommendations, but some will have to wait because the government has yet to receive a final report from a committee appointed last year to draft a provincial mental health and addictions strategy.

"There are a number of actions and activities that are very significant that will make a real difference for people who are suffering from a mental illness," MacDonald said, adding that 911 dispatchers have been given a standardized checklist that will help them recognize mental health issues.

Among other things, the province has increased crisis intervention training for police and health-care professionals, and it has established a new, psychiatric intensive care unit at the East Coast Forensic Hospital near Halifax.

As well, a new mental health and justice committee has been appointed, and the province is spending $4 million this year on residential units for people recovering from mental illness.

Aside from the money for the residential units, the province provided no other cost estimates.

Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, said the government’s moves represent an important first step.

"There’s a lot of work to be done yet," he said after the government report was released. "Things have changed immensely because of (Howard Hyde’s) death . . . I think that things are going to change substantially."

Also see:

Province Releases Plan to Improve Care in Custody

Building Bridges: Improving Care in Custody for People Living with Mental Illness

Hyde Fatality Inquiry


Image credit

Mental health session draws ideas, skeptics

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

Committee seeks input from people affected by addiction, other issues

By Pat Lee, Staff Reporter

A public session on how to improve services for those with mental health or addiction issues elicited lots of input Tuesday on where the system needs improvement and a healthy dose of skepticism about the exercise.


While those attending the afternoon-long session in Halifax agreed there is an urgent need for a better way to treat and support those with mental illness or addictions, especially among the young, some said the problems have been studied for decades.

"These are the same issues that have being going on for 25, 30 or 40 years now," one person said. "What’s going to be different?"

Terry Taylor of the Nova Scotia Health Research Foundation, which was handed the task of running the consultations, said he’s not surprised by the skepticism.

"A question we’re asked, not infrequently, (is), ‘What’s different now?’ " Taylor said.

He said people should be optimistic that change will occur because Health and Wellness Minister Maureen MacDonald, who struck the committee a year ago, is "100 per cent committed and passionate about this issue. She has said publicly that she would like this to be her legacy."

Tuesday’s gathering was one of six public consultations organized by the committee that is charged with creating the province’s long-awaited mental health and addictions strategy. The committee is composed of a dozen health experts, researchers, mental health clinicians and people living with or affected by mental illness.

During Tuesday’s session, interest peaked when the discussion turned to the need for improved addiction services around the province, particularly for young people.

Of the 134 beds set aside for the treatment of alcohol or drug addiction, none are specifically for young people, Taylor said.

Many in attendance said it’s next to impossible to get help for mental illness or addiction unless someone has reached a crisis point.

It’s well known that a child in a mental health crisis will not be seen at the IWK Health Centre unless they are thought to be suicidal, Dr. Bob Frederickson said.

"That has to be publicly stated because that’s crazy," he said.

Dr. David Pilon, program leader of specialty mental health services for Capital Health's mental health program, said his staff is overwhelmed. He said 80 or so clinicians assess and treat more than 600 new referrals a month, on top of many other specialty treatment and programs offered at the hospital

"We have reached a critical point where we’re up against a wall," he said. "Less than four per cent of the total health care budget goes to mental health and it no longer computes."

"Psychiatric and addiction care is one of the worst services we have in Nova Scotia," said another physician, who did not want to be named.

"We need more timely access. My perception is that the system is mired in paperwork and passing the buck and working nine to five."

Along with public input, the committee is seeking input from health-care providers, government agencies, non-profit groups and any others involved with or impacted by those with addictions or mental health concerns.

Taylor said the information gathered, which will result in recommendations sent to government sometime in the fall, comes on the heels of work done by Senator Michael Kirby in the area of mental health advocacy. Closer to home, there has also been the Hyde Report by Judge Anne Derrick.

While the report on Howard Hyde, a [man with schizophrenia] who died after struggling with jail guards, focussed on dealing with the mentally ill within the justice system, Taylor said the report also highlighted the need for an infusion of funding within the mental health care system as well as other related recommendations.

Along with the public meetings, including one this Thursday from 9 a.m. to 12:30 p.m. at the South Shore Regional Hospital in Bridgewater, Taylor and his group have met with 67 other groups and plan to talk to about 40 more before the end of the month. The group expects to hear from about 1,000 people before it’s done.

People can also provide input online or through the mail. For more information, go to bit.ly/kCWwE2 or call 424-4043.

(plee@herald.ca)

Photograph by Eric Wynne / The Chronicle Herald

Mental health care: Are our rights to privacy being eroded?

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

By Aileen McGinty

One in five Canadians are likely to experience mental illness within their lifetime. Statistically, this means that about 80,000 people in the Halifax area could be affected by new guidelines on disclosure of information being developed by Capital District Health Authority’s Mental Health Program.

The Mental Health Program was advised, rightly or wrongly, last year during a visit by the Meriden Programme from England that collaborative mental health care in Nova Scotia is restricted more than in most other places in the world by the emphasis on confidentiality.

Capital Health’s response to this is to develop new disclosure guidelines together with "champions of disclosure" in their various teams. What the Mental Health Program does not appear to appreciate is that you cannot get around existing legislation simply by introducing new policy. If legislation is required to be changed, there is an appropriate process to be followed. The danger with the direction taken by Capital Health is that the new policies may not be in compliance with legislation, leaving the organization open to challenge.

The draft disclosure guidelines prioritize the rights of family members of those with mental illness over the rights of the individuals living with mental illness. ("Family" is defined as those whom the patient identifies as supportive.) Families play an extremely important role in the lives of many of those with mental illness; however, the rights, dignity and respect owed to the individuals concerned must take priority.

These rights cannot be ignored as they are enshrined in the UN Convention of the Rights of Persons with Disabilities. On a provincial level, the Freedom of Information and Protection of Privacy Act provides that all public bodies are obliged to ensure the protection of an individual’s personal information.

In essence, the draft guidelines as written advocate manipulation and obfuscation of people who are vulnerable and likely to be in distress. In any discussion, clarity is paramount, but especially so when that discussion involves someone who may be distressed, confused or anxious.

These draft guidelines advise professionals not to ask someone whether they want their personal information kept confidential, but rather assume consent and ask only which information can be disclosed and to whom. Many people with mental illness as well as human rights professionals, both in Nova Scotia and other provinces, are finding this extremely disturbing. It is essential to inform someone that they have a right to keep their personal information confidential.

It is unlikely that any other health-care information would be treated with such a cavalier attitude and it may be possible that CHDA Mental Health Program could be setting itself up for complaints of discrimination on this basis.

Collaborative care is an important factor in the treatment of any illness. I am a great supporter of collaborative care generally, and am presenting on this very topic at the 12th Canadian Collaborative Mental Health Care Conference to be held in Halifax in June this year. However, research on collaborative care is quite specific about which particular circumstances lead to improved patient outcomes. It is simplistic to state (as in the draft guidelines) that "research shows that good supports improve patient outcomes," especially without referencing that statement.

My aim in highlighting this issue is not to be dismissive of collaborative care. My concern is to ensure that the individual’s right to privacy of personal information is not eroded.

The consultation period for this document was very short and the deadline for comments has passed. However, given the importance of this matter to so many people, I am sure that CDHA Mental Health Program would still be open to listening to the views of the public and other relevant bodies before completing the final document.

Aileen McGinty is a member of the Mental Health and Law Advisory Committee of the Mental Health Commission of Canada.

Also see:

Personal Directives in Nova Scotia

Personal Directives Act

Personal Directives Regulations

Personal Health Information Act (not proclaimed in force)

Carers and confidentiality in mental health - The Royal College of Psychiatrists (2010)

Rethink Policy Statement 27: Confidentiality and information sharing

SDO briefing paper – Information Sharing

Confidentiality and Information Sharing Reference List

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)

Changing attitudes about mental illness

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

Hyde Report a positive step, says schizophrenia society boss

By Ian Fairclough | FIVE QUESTIONS

Last week, a provincial court judge released a long-awaited report from the inquiry into the death of Howard Hyde, a Nova Scotia man with schizophrenia who died in jail a day after being arrested by police.

The report contained 80 recommendations and was welcomed by Stephen Ayer [pictured], the executive director of the Schizophrenia Society of Nova Scotia.

Q: What’s the most important lesson to be learned from the death of Howard Hyde?

A: There are three really important lessons; it’s hard to pick one of them.

The most important lesson is a combination of the need for increased education around mental illness and what to do when encountering a person who is in a state of psychosis.

There is also the need for communication not only with the individual who is in the psychotic state, but also communication between different agencies that would be interacting with that person, from the mobile mental health crisis team to 911 to the responding officers. Communications has to be better.

In relation to that is response. If we could increase the education and training of people who respond to situations where an individual is in a crisis with a psychotic episode, they would be able to communicate effectively between themselves and the other agencies or services involved, and then the response would be the most appropriate response for that individual.

Q: What’s the first thing that should be done?

A: We have to have some empathy and some humanity in terms of dealing with people who have a psychiatric emergency, no matter what the circumstances may be.

Q: What do you think it would take to change the way police and the justice system deal with mental health consumers?

A: One of the deputy sheriffs did a great job trying to calm Mr. Hyde down to the best of his ability. He took two hours to talk to Howard Hyde to get some insight into what was going on, so there are people who are understanding and empathetic within the system already.

I’m sure there are more than (him). I think police and correctional services need to take a look at their staff and identify people who would be most appropriate for training in regard to working with people who are having a psychiatric emergency and being able to understand how to deal with it appropriately and get the person the help they need.

Q: How are the supporters of people with schizophrenia reacting to the results of the inquiry?

A: Very positively, and I am as well.

As I reflect now on the report and having delved deeper into it over the last couple of days, my response is the same as it was initially. This is an incredible piece of work by an incredible person — Judge Derrick — and when this was released, I said it’s a watershed day for the people of Nova Scotia and all people who live with mental illness in their families. It’s so comprehensive and the recommendations are so thorough and so important. I continue to believe that and hope the report will be taken seriously by government and others who need to make changes within the way they provide services.

Q: How optimistic are you that at least some of these recommendations will be instituted quickly, and how likely do you think it is that they’ll all be accepted?

A: In terms of the word quickly, I’m not very optimistic at all. In fact, I’m quite pessimistic, because this government has shown that even though it talks the talk, so to speak, and we have a health minister who is a former social worker and who worked at the Nova Scotia Hospital years ago and campaigned on the fact that mental health was going to be a high priority, when push comes to shove and the rubber hits the road, she’s nowhere to be found in terms of making some changes.

That includes support for community organizations such as ours that are on the front lines dealing with crisis calls.


BY THE NUMBERS

• About one per cent of Nova Scotians are living with schizophrenia.

• About 23,000 family members are affected by schizophrenia in that they are trying to help their loved ones deal with it.

• About 30 per cent of people with schizophrenia completely recover, and another 40 per cent recover well enough to work with limitations. The other 30 per cent are so affected they are difficult to treat.

• The Hyde Inquiry [report] contained 80 recommendations among its 462 pages.

• In the past year, the Schizophrenia Society of Nova Scotia answered more than 500 crisis calls and provided advice, information and assistance.

Source: Schizophrenia Society of Nova Scotia


(ifairclough@herald.ca)

Photograph by Peter Parsons, The Chronicle Herald.

Hyde report: Call to action

An editorial published in the December 10th edition of The Chronicle Herald:

In Judge Anne Derrick, Howard Hyde finally has an advocate who sees the bigger pic­ture. Sadly, proper perspective is the very thing he desperately needed from someone — anyone — the day he died three years ago.

That much is obvious from reading Judge Derrick’s findings into the chain of events that led to the death of this emotionally disturbed man. But those who comb through the inquiry report looking to pin blame will be disappoint­ed. Howard Hyde — who suffered from schizo­phrenia, was off his medications and experi­encing psychosis — was not a victim of in­competence. He was a victim of incoherence.

During every step of his odyssey in police, medical, court and correctional custody, Mr. Hyde came across professionals acting profes­sionally. Even the most controversial and publi­cized episode — which led to Mr. Hyde’s mul­tiple Tasering at a Dartmouth police station — is not a slam-dunk of police misbehaviour.

Judge Derrick notes that the booking officer who produced a tool with which to cut the lace on Mr. Hyde’s shorts before putting him in a cell did not mean to provoke or panic him.

“S/Cst. MacCormick uttered the words: ‘We’ll have to cut one of those balls off’ innocently, with no appreciation of the effect they would have on Mr. Hyde," she wrote.

Judge Derrick makes it clear that the Taser­ing did not cause Mr. Hyde’s death. Nor did he die of schizophrenia, as the medical examiner unhelpfully concluded. He did die some 30 hours later as a result of a struggle with Burn­side jail correctional officers whose use of force, and of a restraint hold, she determined to be “reasonable and proportionate."

Ultimately, the real problem was not the performance of Mr. Hyde’s custodians per se, but crucial omissions cascading through the chain of custody. From the moment he was first picked up by police on a domestic abuse com­plaint, a pattern developed whereby relevant facts weren’t passed along. Legal and medical professionals got their wires crossed, made incorrect assumptions, acted on incomplete information. Cops were unaware of mental health resources available to them and guards didn’t know how to de-escalate confrontations with the emotionally disturbed.

Clearly, the province must begin by training its sights on retraining front-line staff.

(edits@herald.ca)

Busy first year for chief C.B. Crown

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

MacRury headed inquiry into jail cell death of mentally ill man

By LAURA FRASER Cape Breton Bureau | FIVE QUESTIONS

Dan MacRury [pictured] spent most of his first year as chief Crown attorney for the Cape Breton region juggling his new job with his responsibilities as counsel for the Howard Hyde inquiry.

The inquiry into the death of the mentally ill man while in custody was one of the province’s longest fatality probes.

But MacRury said he is used to tackling more than one job at a time. He will be the incoming vice-chairman for the criminal justice section of the Canadian Bar Association, and treasurer of the Nova Scotia branch.

He has also sat as president of the Legal Information Society of Nova Scotia and the Canadian Criminal Justice Association. And in his spare time, he goes fly-fishing and makes pasta.

He recently sat down with The Chronicle Herald to talk about his 24-year career shortly after he won the Canadian Bar Association’s 2010 John Tait Award of Excellence.

Q: What sparked your interest in public prosecution?

A: I’ve been involved in public service pretty well my entire career. First, I was at (Nova Scotia) Legal Aid and then moved over to the Crown.

I think it was sort of natural for me because public service and volunteerism are sort of virtues of my family. My entire family works as public servants.

My father worked as a hospital administrator and a city councillor here in Sydney. My mother was a nurse in detox. Both sisters work in health care, and in fact, I married a public servant. My wife’s a public servant.

It’s certainly something that was instilled in my family as being very important, to give back to your community and try to make a difference, and that’s really what I’ve been trying to do throughout my career.

Q: So what was it initially that interested you about law?

A: I had a very good professor who was sort of a mentor and went on to be a senator. John. B. Stewart was my professor at St. F.X., and he was somebody that always encouraged people to go into law, and I guess that was where my interest was tweaked at that point in time.

And certainly as a lawyer, I’ve had some great opportunities. I’ve been involved as a defence counsel in two murders and as a Crown in seven murder cases. I’ve appeared before the Supreme Court of Canada three times, one being the (John Robin) Sharpe case that dealt with the constitutionality of the (child) pornography provisions of the Criminal Code.

And I was a legal adviser in 2002 to the G7 finance ministers conference in terms of the law and its relation on lawful assembly and protests.

Q: Recently, you were the counsel for the Howard Hyde inquiry regarding the death of a man with schizophrenia who died 30 hours after he was Tasered while in police custody in Halifax. Can you tell us about that?

A: The Hyde inquiry, of course, was the longest fatality inquiry in Nova Scotia history, and that dealt with issues of how the mentally ill are dealt with by the criminal justice system and the mental health system. We’re now awaiting Judge (Anne) Derrick’s report and certainly hoping that there will be recommendations in relation to those areas as well.

One thing that I’ve found both as a legal aid lawyer and as Crown over the last 20 years is that, really, there are too many people that suffer from mental illness that are being dealt with by the criminal justice system instead of the mental health system. That’s something that I always felt was important to try to improve if we can.

Q: What do you remember about your first case?

A: When I first started out in New Glasgow (as a lawyer with Nova Scotia Legal Aid), you dealt with a lot of people, and you realize that people don’t choose, and don’t have control over some of the circumstances (that affect criminal behaviour), whether it’s poverty or substance abuse. So a lot of times what you found as a legal aid lawyer is that people are just looking for help.

I guess one case that sort of stuck out in my mind is I represented a young man who had been institutionalized for most of his life, and disabled. It certainly brought home to me that sentencing sometimes has to be flexible because it was a serious offence that he was charged with and the jails couldn’t cope with him. We were able to speak with (the) correctional services (division of) Nova Scotia at the time and we were able to have him transferred to a hospital setting, which was more appropriate for him. He was able then to get at rehabilitative programs, and it was the only time he’d been involved in the criminal justice system that he was able to get programs to assist him. Certainly, that was very rewarding from my point of view. What we find is that when things aren’t as simple, you have to be a little innovative in terms of coming up with solutions to problems.

Q: You said that you’ve prosecuted seven murder cases.

A: One I got parachuted into. I think what you learn in this business is things happen on short notice. I had a vacation booked for New York City, and a colleague became very ill. With two weeks to go, I ended up being involved in the case in Halifax (R. vs. Assoun). And that was a long case where the accused fired three lawyers and was then self-represented, which was certainly a challenge.

I was involved in another case (R. vs. Tran) that was simultaneous translation in Vietnamese. In fact, while I was dealing with the Tran case . . . at the same time we were prosecuting another case called Simpson, which was somebody on a Cuban vessel that murdered somebody in Halifax Harbour. So, literally, we were going to jury on one case, and then up at the provincial court starting the other case, which was translated in Spanish.

The challenge in the case in the gentleman from Cuba is that all the witnesses were in Cuba and so we had to deal with Foreign Affairs to try to get them back in the country to testify . . . so it wasn’t your standard subpoenas. Certainly, that was a challenge, but an exciting case as well."

(lfraser@herald.ca)

Photo credit

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