Hi,

Some interesting reading on mental health in Ontario below.  Hopefully, this
will be more legible.

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.