Friday, March 15, 2013

BC's Collapsing Mental Health System for Children, Youth & Adults

My Op-ed on the failures of the BC government to properly fund, monitor and take leadership on the collapsing mental health system for children, youth and adults. 

Tracey Young: How many must suffer, die, before action?

The Province, February 8, 2013.

How many children have to hurt themselves or take their own lives before there is action? How many people have to be critically injured or murdered by individuals who are acutely mentally ill and in urgent need of psychiatric care before the B.C. government takes responsibility for the fact that the child, youth and adult civil mental-health systems are failing an increasing number of people?

The names in the media articles change, but the stories remain the same: mentally ill people, some of whom are openly aggressive and violent toward others, often family members, or those who express suicidal and homicidal ideation to mental-health professionals, deteriorate to the point where they hurt themselves, harm or kill others. These incidents are not random and we must connect the dots to see why this is happening in B.C.

When family members see tragedy bearing down like a runaway freight train, why do they have to struggle alone and powerless to get their loved ones help from the only systems set up to provide it — the community mental-health system and the acute-care psychiatric services in hospitals?

Having worked as a psychiatric social worker in the youth and adult forensic psychiatric and civil mental systems I am unequivocal in stating that mental-health assessment and treatment has never been more difficult to access for children, youth and adults. The system of care from community mental health to acute psychiatric-care units, to long-term tertiary care, to supportive community housing is vastly underfunded and understaffed.

Many professionals working in this area of practice also do not have adequate training and ongoing professional development to ensure they are working together to provide the most competent, ethical and evidence-based care possible.

If someone has a broken arm, an acute heart condition or any other serious physical condition we would not dream of denying them access to health care. This is radically different for mental-health injury and illness for people of all ages. Mental illness continues to be stigmatized, just like those who suffer from mental health issues, who face extraordinary discrimination in daily life.

The B.C. government, in their 2010 report, Healthy Minds, Healthy People, stated that “over any 12-month period, about one in five individuals in the province will experience significant mental-health and/or substance-use problems leading to personal suffering and interference with life goals.” So they have at least recognized the immensity of the problems that occur for individuals, often starting in childhood.

The report goes on to state that a “recent Canadian study has suggested that mental illness costs the Canadian economy $51 billion annually in lost productivity — B.C.’s proportional share of this burden would be more than $6.6 billion each year.” In spite of creating these lofty reports, which lack concrete plans, something is going horribly wrong in the process of designing, implementing and carrying out services around B.C.

Thankfully, the office of the Representative for Children and Youth is studying the child and youth mental-health system, but the entirety of B.C.’s mental-health system of care from cradle to grave must be put under the microscope. Mental-health services are fragmented and regionalized across six different health authorities and the Ministry of Children & Family Development for children and youth.

All of these organizations have created their own bureaucratic infrastructures and administrative cultures, which has led to a serious lack of oversight, monitoring and accountability and no cohesion, sometimes even within the same organizations.

The B.C. government must take strong, decisive leadership to create a comprehensive, accountable plan that includes measurable goals for mental-health services across the province to ensure timely access to care and best practices in assessment and treatment are occurring within the system, within all program areas and organizations providing services.

Efforts must also be made to change the structure and culture of practice within the mental-health system of care. As many families find there are complex barriers to accessing both community and acute psychiatric hospital care for children, youth and adults. If individuals make it into acute-care units, structural and administrative priorities of moving people out of acute-care beds as fast as possible have replaced client-centred care, treatment and effective discharge planning to ensure that gains made in hospital are maintained as people transition back into the community.

There must also be increased training for clinicians working in the system in assessing risk of self-harm and violence toward others as it has become all too clear that the civil mental-health system is often failing to adequately assess these risks.

In media story after story we learn that individuals were given cursory assessment and “treatment” in the civil system and then went on to commit violent crimes, often later being found Not Criminally Responsible on account of Mental Disorder.

A provincewide acute psychiatric care system that prioritizes getting people out of beds over a slower, measured process of assessment and treatment is leading to a normalization and minimization of risk factors that put individuals at risk.

Albert Einstein said the definition of insanity is doing the same thing over and over again and expecting different results. I am labelling the current B.C. government as the ones who are insane for sitting on their hands, year after and year, ignoring the tragic failures, impacts and loss of dignity and human life that is resulting from the failures of the mental-health system of care that they have created.

With the provincial election occurring on May 14, it is time for all political parties to get real, get concrete and to stop twiddling their thumbs and inform voters what their strategic plans are to improve the mental-health system of care for children, youth and adults.

Individuals with mental illness, family members, professionals working in the field and concerned citizens have surely run out of patience waiting for the B.C. government to improve accessibility to the entire range of mental health services needed, improving outcomes and enabling people to live with the dignity and rights that everyone else takes for granted.

Tracey Young is a registered social worker, a consultant and counsellor in private practice, a writer and an advocate.