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Mental Health Report Web Version Reality Ontarios Mental Health Care System isnt working A report by the Ontario Public Service Employees Union November, 2002 1 © Ontario Public Service Employees Union – 2002 2 Table of Contents Acknowledgements ............................................................4 Introduction ......................................................................... 5 Background .......................................................................... 7 Executive Summary: 10 Systemic Failings of Mental Health Care in Ontario ..................................................10 Chapter 1: The Health Services Restructuring Commission29 Chapter 2: Mental Health Implementation Task Forces ....35 Chapter 3: Funding .............................................................38 Chapter 4: A Home, a Friend, a Job ...................................43 Housing .........................................................................44 Employment ..................................................................47 Income ...........................................................................48 Chapter 5: Bed Numbers...............................................50 Chapter 6: The Seriously Mentally Ill ..........................53 Forensic patients ...........................................................53 Chapter 7: Integration and Streamlining ............................58 Chapter 8: Regional Reports .............................................62 London and St. Thomas ................................................62 Hamilton and Niagara ...................................................66 Toronto ..........................................................................69 Whitby ...........................................................................76 Penetanguishene ............................................................80 Kingston ........................................................................84 Brockville and Ottawa ..................................................89 North Bay and Sudbury ................................................94 Thunder Bay ..................................................................97 Chapter 9: Recommendations ...........................................102 Appendix 1: The divestment of Provincial Psychiatric Hospitals......................................................................103 Appendix 2: OPSEU’s publications on Mental Health ....104 Appendix 3: Participants in OPSEU forums.....................105 3 Acknowledgements The Ontario Public Service Employees Union would like to thank: The 92 OPSEU members from 20 workplaces around the province including: current and former Provincial Psychiatric Hospitals, general hospitals, community agencies, correctional facilities and probation and parole offices, who participated in the 10 regional workshops that produced the content of this report. Their commitment and passion for working with and for the mentally ill is obvious from their heartfelt comments and observations about a mental health system that is in crisis. OPSEU First Vice-President Smokey Thomas, the local presidents of the current and former Provincial Psychiatric Hospitals, and the OPSEU Mental Health Division Executive for inititating this research project, and for guiding it to its completion with their ideas, knowledge and experience of the mental health system. Janet Solberg for researching and writing the report. Megan Park for facilitating the workshops and editing the report. Katie FitzRandolph for editing and design. I am proud of this union’s on-going and sustained advocacy on behalf of a sound system of mental health for Ontario. Our record speaks for itself. The tragedy is that so many governments have failed to listen to the heart-felt pleas of front line workers and the clients they serve. May this be the last time we have to convey this message. Leah Casselman, President 4 Introduction On November 26, 2000, a search team found Barbara Skultety’s body behind a Collingwood Lumber yard, a day after she went missing from Collingwood General and Marine Hospital. Eighteen months later, a coroner’s jury concluded that Skultety, 49, had committed suicide after being admitted as an involuntary patient at the Hospital. She had spent four days on a stretcher in an emergency room cubicle as doctors searched in vain for a psychiatric bed. Collingwood General and Marine Hospital has no psychiatric facility so staff tried to arrange for Skultety to be transferred to the Mental Health Centre in Penetanguishene or to the psychiatric ward at Barrie’s Royal Victoria Hospital. “She had lost her right to freedom, but there was no bed for her to go to,” said She had lost Coroner James Kovacs. her right to freedom, but The coroner’s jury agreed. The jury members called for “immediate action, in particular to provide adequate funding to ensure that all persons requiring there was no bed mental health services have immediate access to prompt, safe, and secure for her to go to. medical treatment.’’ In the months before her death, Collingwood hospital officials pleaded with the Ministry of Health to open more psychiatric beds in Simcoe County, the inquest heard. The ministry added five additional beds to the health centre in Penetanguishene, but not until several months after Skultety’s death. “How could this happen in our society? ... It makes you wonder what’s happened to health care, said Kovacs, adding psychiatric care has been “hardest 1 hit” under the Ontario government’s health care restructuring. 1 “Inquest tries to see how Barbara Skultety was a casualty of the restructuring. So, too, were Wayne system failed woman,” Collingwood Connection, Cutler, 31,Cory Wibberley, 20, and David Lumgair, 32, all of whom killed Roberta Avery, May 8, themselves at the Grand River Hospital in Kitchener over a four-month period 2002. from November, 2000, to March, 2001, while waiting for treatment for mental 2 “54 steps urged to prevent health problems. 2 suicides; Victims’ families like jury proposals; hospital OPSEU members are on the front lines of mental health services in Ontario. says it can’t afford them”, They have witnessed the suffering that the dismantling of yet another vital The Kitchener-Waterloo public service has caused consumers and their families. Record, Frances Barrick, February 16, 2002. 5 The union represents 7,000 front line staff in Ontario’s Provincial Psychiatric Hospitals, general hospitals and community agencies who work with the mentally ill. OPSEU members are registered nurses, registered practical nurses, social workers, maintenance workers, vocational rehabilitation counsellors, housekeeping attendants, psychometrists, occupational therapists and cooks. They work in a variety of settings: in acute-care wards, out-patient clinics and community outreach teams known as ACT (assertive community treatment) All this teams. restructuring The dismantling and restructuring process has been heartbreakingly familiar. created so much First, the Conservative government proceeded to cut corporate and income tax turmoil and thereby depriving the government of billions of dollars of revenue. disruption and Then they declared a shortfall in the budget and moved to cancel vital programs administrative in education, health, housing, environment, transportation, social services and busyness at employment – all the while vowing that the public sector must learn to do more every level with less. that thoughtful At the same time – and this is key – the Conservative government moved to and informed restructure whole facets of public life. They forced the amalgamation of city analysis could councils, fire departments, libraries and boards of education. They downloaded barely be the responsibility for transportation, social services and public housing to cities mustered. already starved of cash. They passed legislation that fundamentally changed how the education system would be financed. They restructured hospital care and homecare and moved to deregulate energy and electricity. All this restructuring created so much turmoil and disruption and administrative busyness – at every level – that thoughtful and informed analysis could barely be mustered. The same Conservative government template is now being applied to the area of mental health with predictably disastrous results. OPSEU held workshops with our members across Ontario to find out from them the effects of the restructuring of mental health services. They told us that mental health services are in a critical state. Sure, there were gaps and faults in the ‘system’ previously. But the current hodgepodge of funding arrangements, and governance arrangements, and divestment, and re-investment, and bed closings, and bed transfers, and program closures, and program start-ups, and proposed hospital closings and proposed hospital building, all of this has put treatment, care and services for people with mental illness in chaos. That state of chaos is the impetus for this report. Front line staff are deeply concerned that the well-being of people with mental illness is being lost in a hastily conceived, shoddily implemented and sadly underfunded plan to reform the mental health system. 6 Background Reform of Ontario’s mental health system has been in the works for more than four decades. Historically, people with serious mental illness were cared for and treated at the 10 Provincial Psychiatric Hospitals (PPHs) owned and operated by the government. In the 1950s, with the advent of psychotropic medicine, many of these
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