Reinventing the Wheel -The Health Standards Organization

By Marvin Ross

In mid October, Bridgeross author Susan Inman (After Her Brain Broke), did a piece in Huffington Post about standards for mental health services in Canada being developed by an organization in Ottawa called Health Services Organization (HSO). Susan pointed out that “HSO minimizes the impact of severe illnesses and then fails to suggest needed services. It’s important to note that the committee creating these standards did not include any psychiatrists

In the Tyee, Susan pointed out that with these new standards, those with severe mental illness will wind up getting even worse care than they do now. I agree with Susan on the absolute stupidity of developing guidelines on an illness while not consulting doctors who treat people with those illnesses. That’s like developing standards of care for those who have heart attacks and neglecting to include cardiologists in the development.

Their draft standards were open for consultation till the end of October and I gather they are still considering the comments that they received.

My blogging partner, Dr David Laing Dawson, summed up the gist of their standards into one sentence:

“We should all treat each other nicely and kindly and use as many euphemisms as possible.”

One of my readers complained to them as well about the lack of psychiatric input and was asked if she could recommend a shrink. My only reaction to that is to quote Little Richard and “good golly miss molly”. This is an organization “formed in February 2017, to unleash the power and potential of people around the world who share our passion for achieving quality health services for all. We are a registered non-profit headquartered in Ottawa, Canada.”

Are they not capable of finding psychiatrists?

The Canadian Psychiatric Association (CPA and also in Ottawa) is only 4 miles away from them in the same city. A short cab ride (Uber if you prefer) or they could meet in the middle. But then, when the CPA found out about what they were doing, they sent them a letter. On October 26, the president of the CPA told them that “I am writing today to express the CPA’s concerns about the proposed standard, and in particular, about the composition of the advisory committee, which did not include any psychiatrists.” You can read the full letter here.

On November 3, psychiatrist Nachiketa Sinha wrote a blog on the CPA site suggesting that the disregard for experts in mental health is a symptom of the stigma that mental illness faces. Dr Sinha added “How can I possibly trust that the care I am receiving is appropriate for my illness if the policy and programs have been created by laypeople, administrators, and NO EXPERTS on my mental illness and the care I need?”

And while I used the example of heart disease standards needing cardiologists to develop them, Dr Sinha wondered if anyone would trust a bridge built by people with no engineers involved.

On twitter, HSO commented to Dr Sinha that they are “trying identify a psychiatrist to join this committee.” Again, “good golly” how hard can it be to find experts to work on this? And I should point out that the CPA along with similar organizations in other countries, does produce clinical practice guidelines that detail how various diseases should be best treated based on all of the current evidence. CPA has guidelines on the treatment of anxiety disorders, depressive disorders and schizophrenia. And, of course, so does the American Psychiatric Association. And we should not forget all of the reports (over the course of 11 years) developed by the Mental Health Commission of Canada.

Do we really need someone else to reinvent the wheel at considerable cost? The money wasted could be well spent on funding more beds which are desperately needed.

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10 thoughts on “Reinventing the Wheel -The Health Standards Organization

  1. It was ever thus. I repeat myself . Forgive my fury! . Yes Dawson is absolutely right when he points out the idiocy of what the system, plans to do he summarizes

    “We should all treat each other nicely and kindly and use as many euphemisms as possible.”

    Now my anger and unrest surges. In 19 79 /80 I sat on a Canadian Mental Health Association Committee for several months. I left because nobody knew anything about what serious mental illness really looked like. They were planning in such an unrealistic fashion. At the same time bed reductions were the order of the day and professional health care workers ,doctors and nurses were highly suspect..In fact half the time they were being blamed for abusing patients as far as I observed. MY sitting on committees at Queens park was more of the same nonsense for the most part.

    A very famous bridge in Scotland was predicted to collapse by an engineer. It did . And so will the HSO Plan for care for the seriously ill when it is put forth by ignorant planners. But let us not ignore their incompetence and call them out .Forty years of nonsense has brought us to this un-pretty pass Seriously untreated psychotically ill folks flood our streets. And what do they do form another committee to spout about their solutions. The “wellness brigade is at it again , but will spend money wildly and do nothing for those in most need but they will feather their shady nests

    If I were ten years younger i might get out my bow and arrow and pierce the insipid nonsense.

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  2. So many questions, so few answers. Marvin, is there a Canadian governmental entity that provides healthcare standards? Why does the nonprofit organization, HSO, has any authority to provide a role that should be governmental? If I were an investigatory journalist, I would find out the funding source of HSO. is one wealthy person funding it and driving the philosophy? What is that story?
    There is a difference between clinical guidelines, which you emphasized, and organizational/systemic standards of care. By the way, did you look at the clinical guidelines you referenced (CPA and APA)? Pitifully lacking!
    Try https://www.ahrq.gov/ if you want better clinical guidelines.
    You were correct in saying psychiatrists should be involved but be careful in selecting those who understand organizational standards. My experience is most mental healthcare clinicians are not talented or interested in addressing issues broader than one patient at a time. This is true in all professions. I have a long history of leadership roles in establishing policies and standards fo mental healthcare, and I found few of my colleagues were interested in those non-clinical responsibilities.
    Bottom line, I got a headache trying to understand what the HSO was, what is it’s authority, and what is it’s driving source of funding and philosophy. Standards of care and accreditation should be a governmental or professional organizational function. The HSO is an enigma.

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    1. Thanks for your comments Robert. Health care in Canada falls under provincial jurisdiction so each province develops their own standards. the question that I should have asked of HSO is did anyone ask you to do this. I suspect the answer is no one did. They are an offshoot of the Accreditation Council which does their bit accrediting hospitals and HSO sells their standards for $100 each. I wonder if anyone buys them? Personally, I think think this is nothing but a make work project for a bunch of officials with little else to do. I highly recommend a recent book called Bull Shit Jobs by an anthropologist who suggests that about 50% of all work is bull shit and those doing those jobs know it. This is a perfect example.

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    2. To Robert Powitzky: Accreditation is taken very seriously by hospitals and community mental health organizations here in British Columbia. Unfortunately, Accreditation Canada https://accreditation.ca/ appears to have SUBCONTRACTED the development of new standards to HSO — which appears to be part of some larger, multinational organization of mysterious origins. In any case, their shoddy work and obvious ignorance is astounding. (When I completed HSO feedback form on draft mental health standards, it asked for my zip code)

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  3. That’s pretty scary isn’t it? I wonder if they consulted any mental health nurses. I am a mental health nurse and a mother of an adult son who has schizophrenia. I have worked as a nurse in early psychosis both in Canada as well as in Australia and am well aware of the importance of early diagnosis and intervention. My own son is living autonomously and working (paying taxes too by the way) . If it hadn’t been for the early treatment by psychiatrists and ongoing case management by an assertive community treatment team, he would have killed himself. Or he could have killed me. Or be living on the streets floridly psychotic .That’s the truth and that is the world that mothers of adult children with schizophrenia live in. Wake up Canada. If they want the name of a good psychiatrist, just ask a nurse.

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  4. Hi Marvin,

    We read your post and find it motivating to see someone advocating for the best possible standards of care for mental illness. We appreciate all of the feedback we have received on this draft and are reviewing it to ensure that when the final version is released, this standard will be supported by the best current evidence.

    We are working with the Canadian Psychiatric Association to identify a psychiatrist to join the Mental Health Technical Committee. This search involves finding someone who both fits the committee criteria and has the time to participate. We look forward to adding their expertise to the committee that already includes patients and family members, product users, general interest members, and policy makers.

    Specifically, the committee makeup includes the chief psychologist from Corrections Services Canada, an Indigenous clinical psychologist who is a Canada research chair in Indigenous mental health and addictions, an MD from the Forces working in primary care, mental health nurses and major stakeholders (Mental Health Commission of Canada, The Centre for Addiction and Mental Health). These experts represent various levels of the health system to ensure that those perspectives are represented in the standards. We believe that standards set through a rigorous and diligent development process support ongoing quality improvement measures in health care systems, leading to higher quality health services for all.

    Our goal is that the public, policy makers, and providers understand what high quality, safe care means. Unlike clinical practice guidelines, our standards follow the patient journey through the system by including elements of population health to plan services and identify health inequities, chronic disease prevention and management. They also incorporate people-centered care for service planning, patient safety and quality improvement. They are not meant to determine thresholds for appropriate access, wait time, and coverage, although they can be used as a tool to spark dialogue with decision-makers on those topics to improve care based on available resources. They are also not meant to make clinical recommendations regarding the treatment of specific conditions.

    As its affiliate, HSO is built upon Accreditation Canada’s 60+ years of standards development experience; our standards remain at the heart of Accreditation Canada’s program. We are a non-profit, non-governmental organization recognized by the Standards Council of Canada as the only standards development organization in Canada dedicated to health and social services. Governments, health systems, hospitals, clinics, and other health organizations across the country lean on us to develop standards that put patients and families first.

    The current version of this standard is used by organizations in Canada, including health authorities in every single province and territory, and by select government services. We are updating this standard on their behalf.

    Thank you again for sharing your thoughts; your feedback plays an important role in helping us create the best possible standard. All of our standards go through a comprehensive public review process. To be notified of future public reviews and other updates, we encourage you to subscribe to our newsletter at https://healthstandards.org

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  5. I believe that this statement is like closing the barn door after the horse has escaped. It is ludicrous that there was no psychiatrist on the original committee. The ommission has put the Health Standards Organization under a cloud of suspicion and I believe it is too late to retrieve its credibility. Sorry to be so harsh, but families of the seriously mentally ill are already contending with unrealistic privacy legislation, reduced hospital beds, premature discharge, revolving door medicine, professions who do not work collaboratively with each other let alone work with the family and mental health professionals who do not know the symptoms of schizophrenia and other psychotic illnesses and autism. There is not enough supportive housing to care for our loved ones when we pass on. There is also a plethora of publicly funded non science based services out there that can cause harm. The money spent on them could be put into getting more access to effective treatment which would help address stigma as there would be less sick people wandering the streets. And now this development of a draft standard about mental illness without the input of a psychiatrist. This does not make sense.

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    1. Agreed. The fact that it was not considered necessary to have psychiatrists on the outfit in the first place illustrates the bias. Whilst conditions like schizophrenia are not considered medical conditions by policy people shows the level of ignorance. Sadly we live in an age where some policy people have little idea that a compromised brain is expected to understand the need for medical treatment. Do they even know about anosognosia for example?

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