Hi,
Some interesting reading on mental health in Ontario below.
All the best,
Debbie Blondell
Mental Health Promotion Unit
Health Canada
Don't scrimp on mental health
The Ottawa Citizen
The closing of beds in Ontario's 10 psychiatric hospitals is a
step in the right
direction, toward treating those suffering from mental illness
in their homes
and communities rather than locking them away. But these beds
must be
replaced with services in the community, and that will take a
lot of money.
Elizabeth Witmer, the minister of health and long-term care,
recently
announced another $46 million in support of the community-based
care that
will replace hospitalization. That's good, but barely a patch
on what's
needed.
Once upon a time, the only treatment for mental illness
amounted to
imprisonment. The government and charity groups operated insane
asylums,
where the mentally ill could be segregated from society, for
their own
protection and that of others. Psychosis and bi-polar disorder
were treated
in more or less the same way, because it's all anybody knew how
to do.
That changed in the late 1960s, with the advent of psychotropic
drugs that
could control the symptoms of mental illness and allow victims
to live much
more normal lives, with homes and families and jobs. At the
time, a large
number of people were released with prescriptions, and wished
good luck.
That didn't work very well, either. Now, the emphasis is on
letting people
live on their own as much as possible, and giving them the
employment,
housing and social support they need in order to do it.
Ministry of Health
spokesman Dan Strasbourg says several studies have shown that's
what
works best. Hospital-based treatment will still be available in
a "re-balanced"
system, but won't be the centrepiece of psychiatric care in
Ontario.
Both George Langill, head of the Royal Ottawa Hospital, and
Glenn
Thompson, the executive director of the Ontario division of the
Canadian
Mental Health Association, agree that community-based care is
the way to
go. Mental illness is rarely acute, says Mr. Thompson -- unlike
a broken leg,
it doesn't get better in time. Most patients go through cycles
of illness, getting
better and worse throughout their lives.
Mr. Thompson says mental illness is bad enough without having
physical
separation from the ordinary world reinforced by mental
alienation. Patients
simply do better when they can be supported by family and
friends in their
own homes.
It make sense financially, too. Mr. Thompson says a day in a
psychiatric
hospital costs $550 to $600, while Mr. Langill estimates it
more
conservatively at $250 to $450, depending on the level of care
required.
There are no hard accounting numbers on community-based
treatment; Mr.
Thompson says it can cost as little as $75 a day, while Mr.
Langill says the
cost could be comparable to hospital-based care. Even if Mr.
Langill's right
about that, paying the same money for a system that works
better makes
sense.
But there's a problem. Ontario's mental health-care system is
still focused on
treating people in hospitals. The Harris government is
committed to changing
that, but has been slow in actually making the change happen.
As is often the
case, the expense is getting in the way.
Psychiatric hospital beds can't be closed until the
community-treatment
system is in place to assist the people who will be released.
That means
carrying both the hospital-based system and the community-based
system on
the provincial budget for some crucial transition years.
Estimates of the
startup cost for the community system range between $400
million and $600
million, and even Ms. Witmer's estimate --which Mr. Thompson
and Mr.
Langill unequivocally say are too high -- is that only $260
million or so has
been put into the pot.
Mr. Thompson says $240 million is still needed to set up
community-based
treatment, and $250 million more has to go to ancillary
services like housing
and employment aid, to make sure newly released patients can
make the
transition to independent life. They need distinctly unexciting
things like
"clubhouses" where they can meet for support.
Thus far, the government has spent the most money on "assertive
community
treatment teams," which handle patients who tend to resist
psychiatric
treatment, and exceptional-care programs, which help patients
through
crises. These are undeniably important, but aren't the heart of
a
community-based approach to treating mental illness. The
Ministry of Health
says the pace of reform is slow simply because enhancements
take time to
be done right. And yet a number of psychiatric hospitals,
including one in
Brockville, are slated to close, or be retooled for different
purposes, within
the next few years. If housing, employment, and similar
services aren't up
and running in time, disaster could result. Mr. Langill lauds
Ms. Witmer's
caution, but the clock is still ticking.
Ms. Witmer's heart seems to be in the right place. Her
intentions have to be
supported by the courage to spend money where it's needed.
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