Ontario mental health system faces overhaul
TheStar.com – news/Ontario/healthzone.ca/health
December 29, 2010. Rob Ferguson Queen’s Park Bureau
Ontario is going to change the way its “fractured” $3 billion mental health system works so that people get steered to the help they need, Health Minister Deb Matthews said Wednesday.
Her comments followed a report from an expert advisory panel slamming the bureaucratic maze of agencies and government ministries offering a patchwork of services that often reach people too late — after they’ve had a breakdown or ended up in jail.
The result is that the justice system and hospital emergency rooms get swamped with cases that could have been dealt with more effectively — and at less cost to taxpayers — in community programs.
“The current way of organizing and delivering services is failing Ontarians,” said the report by a panel of 21 front-line mental health experts, including Dr. Rajiv Bhatla, chief of psychiatry at the Royal Ottawa Health Care Group.
Matthews said the criticism is on the mark when it comes to people who are overwhelmed while coping with mental illness or addictions — as one in five Ontarians will in their lifetimes.
“They might have to go to this place for housing, another place for employment support, this place for health services. It’s really tough to navigate and they don’t get what they need,” Matthews told the Star.
The problem is that services are oriented around the long list of agencies and government ministries offering them — not the people who could benefit from a one-stop shopping approach.
“What we need to do is figure out a way to bring it together at a person-centered level,” added Matthews, who has assembled a task force of government ministries to come up with a 10-year plan by next spring.
The 48-page report called “Respect, Recovery, Resilience” contained dozens of recommendations, such as integrating service to make better use of existing resources and intervening early at the first sign of mental illness, addiction or gambling problems.
“For some, the problems are first identified when they get into trouble at school or with the law. All the places where people either turn to or end up in must be able to help or know where to refer,” the authors wrote.
The report tells of one woman who made 83 visits to her local hospital emergency ward in five months last year, before hospital officials contacted the Durham Mental Health Services community crisis team.
The woman was then diagnosed with bipolar disorder and alcohol dependency, placed in a treatment facility for one month and is now back at home while continuing to get care in the community. She hopes to begin working part-time.
The report, ordered by former health minister David Caplan as part of his push to improve mental health services, argues this is proof that a little money spent upfront can get problems under control.
“It’s the right thing to do. Faced with rising health-care costs, it’s the responsible thing to do,” said the report.
Ontario now spends about $3 billion a year on mental health programs plus another $2.3 billion in related law-enforcement services — in addition to the $2 billion a year the private sector spends on disability claims and employee assistance programs for workers with mental health and addiction trouble.
The report also found Ontario spends more per capita on hospital and physician services on mental health and addictions than other provinces, “but this heavy investment . . . has not resulted in a measurable improvement.”
The authors called for more investments in community-based services, a recommendation that is applauded by New Democrat health critic France Gelinas, a physiotherapist before she was elected to the Sudbury-area riding of Nickel Belt.
“We need to make a true system out of all these services,” she said in an interview, noting that an all-party committee of MPPs studying the mental health issue reached a similar conclusion in its report months ago, along with a call for a provincial mental health agency similar to Cancer Care Ontario, which coordinates cancer treatment.
“Right now it makes for a very complex web.” Gelinas added.
“Sometimes people don’t get the best mental health treatment until after they’ve been convicted. Why do they have to wait? It’s an example of the crazy doors people have to go through.”
The report also recommended extending the hours of primary care and community-based mental health and addiction services, such as from 7 a.m. to 11 p.m., which would reduce the odds of people seeking treatment at hospital emergency rooms.
And it calls for better mental health and addiction supports for front-line police officers, such as protocols for them to transfer people in crisis to hospitals.
Matthews said the report reminds her of a 2006 New Yorker story by Malcolm Gladwell headlined “Million Dollar Murray,” about a homeless former U.S. Marine named Murray Barr with an alcohol problem who kept getting picked up by police, taken to emergency rooms and put in jail and temporary treatment programs.
He eventually died because he could not get the constant monitoring he needed to keep on the straight and narrow, and one police officer who dealt with him regularly estimated Murray’s treatment and processing cost the system $1 million over 10 years.
“Everybody who works on the front lines knows a Murray,” said Matthews. “You could spend a lot less money to help a Murray live a lot better life. I think we can do a lot better.”
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