Tag Archives: Emergency psychiatry

Reforming Mental Illness Services is not Rocket Science

By Marvin Ross

Last week’s blog in Mind You by Dr Dawson on rationally planning services made me realize that creating and implementing services for mental illness is not rocket science. Part of my realization arose from two psychiatric emergencies that my own family had to deal with in the past year. Both had fast and positive outcomes unlike so many others. The reasons, I think, are quite simple.

Starting at the front line of service for serious mental illnesses are the police. Every community needs (as my own community has) a police/psychiatric professional team to respond to emergencies. The city of Hamilton has a Crisis and Outreach Support Team called COAST. Their phone line is 24/7 but they also have a mobile team, consisting of a mental health worker, and a police officer, and will respond to crisis calls between the hours of 8 a.m. and 1 a.m. daily.

To supplement that, a properly trained police force sensitive to the reality of serious mental illness and with compassion is required. Yes there are exceptions that receive a lot of publicity but from what I’ve seen personally and from what people tell me, we mostly have that now. I am continually amazed at the extent that many ordinary patrol officers go, to help in these situations.

What many communities lack is an emergency department reserved for psychiatric patients and staffed by specialists which Hamilton does have. Of course, it has to be well integrated with the regular ER with considerable consultation so that people are not wrongly pigeonholed. As so many of you can testify to, the standard reception in ER is to isolate the psychiatric patient and keep them waiting. Then, they are more often than not discharged over the wishes of their family. If they are admitted, it is only for a brief period of time and they are not allowed to properly stabilize. There are never enough beds in most communities.

Recently, a young suicidal girl in Ottawa spent eight nights in the ER and was discharged because their were no beds. In Guelph, Ontario, the emergency room was brought to a standstill recently because there were so many psychiatric patients there waiting for the too few beds available for them. One mother in Vancouver told me how her son with schizophrenia was “tossed out of” an ER in Toronto as the nurse told the mother via long distance that all he needed was a sandwich.

And that is the other crucial piece – hospital beds. I’m fortunate to live in a community with one of the few stand alone psychiatric hospitals left in Ontario. There are beds and while there may be shortages, people usually get to stay if they need to in order to become stabilized. While not every community can have its own psychiatric hospital, they should have sufficient beds in other hospitals reserved for people with psychiatric problems.

Sadly, they don’t and because of that people often get discharged long before they should as the pressure for more emergency beds increases. Thus, what we get are very sick people hospitalized long enough to take the edge off the worst of their symptoms and then tossed out so more emergencies can be handled. It is the revolving door that we have now. The Vancouver mother I cited above also told me that:

Ten years ago, again in Toronto, my son was turfed out of hospital (St. Mikes) after a couple of weeks, at night, into freezing February winter, with no money, no friends or relatives at hand … nothing. It was a terrifying scramble for us, 3,000 miles away, to try to get him into a hotel so he wouldn’t freeze to death on the streets. Looks like nothing has changed.

What is important for those who do have the fortune to stay long enough to be stabilized is to have a caring competent staff who treat them and their families. Hiding behind fake privacy to exclude families from treatment and discharge decisions saves no one other than incompetents who fear oversight. Finally, the last piece is proper discharge planning. No one should be discharged without a place to stay, follow up with an outpatient clinic or community medical staff, and sufficient supports to help them maintain their improvement.

When governments don’t want to do something but want to give the appearance of doing something, they set up a task force or committee to investigate and bring back a report. It looks good to some but does nothing and that is what so many jurisdictions do. Maybe it is because I live in Ontario but this province is the master when it comes to this. Between 1983 and 2011, there have been 16 reports done by the Ontario government on reforming mental health care and few changes. I haven’t bothered to add in all that has gone on since then but it would add to the numbers.

The solution is easy but getting there is not. We will only get there when we continue to press the politicians and drag them into doing what any civilized community should do and that is to properly care for those who are ill. And by that, I mean all the ill.