Where has IWK’s mental health and addictions system gone wrong?
Stories about the IWK’s mental health and addictions services continue to concern the media and Nova Scotians. This is a good thing. Many issues need to be aired.
The first stories in mid-March were about the fact that the IWK was cutting back on its Adolescent Centre for Treatment (ACT) and the Centre for Collaborative Child and Family Treatment (Compass) programs and laying off 22 youth-care workers. Now we read that six more beds are being transferred from the acute-care unit at the IWK to the Nova Scotia Youth Facility in Waterville, Kings County.
In her April 5 column about this move, Marilla Stephenson quoted the Health Minister Maureen MacDonald as saying, "I make no bones about it; it broke my heart when I toured 4 South," referring to the in-patient mental health unit at the IWK. Soon there will be very little left of 4-South for her to tour.
In her March 25 opinion piece, Ms. MacDonald wrote about the IWK’s mental health and addiction services: "… before I became minister, I was very critical of the unacceptably long wait times for families and children needing mental health services. The situation where over 900 kids sat on wait lists with no contact for 18 months to two years, while only a very small number of the most urgent situations got attention, indicated a system that was broken."
Now she seems to think this system is about to be fixed.
I do believe she really thinks the IWK is doing "the right thing" with its reassignment of mental health services-delivery priorities. If the evidence didn’t lead to the opposite conclusion, I would be delighted to agree with her.
However, the IWK’s history in the delivery of its mental health programs makes me wonder if there will be any fundamental change that will lead to "better care sooner" for Nova Scotian children and youth. It appears that the IWK’s priorities when it comes to child and adolescent mental health services have been founded on shifting sand.
I have been reviewing the IWK’s annual reports. I wonder if the minister realizes that since 2002-03, there has been an increase from $9.4 million to $26.2 million in spending by the IWK on mental health.
This is an increase of about 280 per cent in less than a decade. Costs have risen from being about 7.5 per cent of the total IWK budget to being over 12 per cent in 2010-11. And still, in December of 2011 there was a year-long waiting list with more than 1,100 names on it. Obviously a sign of a very badly broken system!
In a March 15 op-ed, IWK CEO Anne McGuire said, "Evidence shows that overnight care is not a necessary part of treatment for most young people. With no impact on patient care, we could reduce costs in two of our programs — Compass and ACT — by moving to a day treatment model for many of these youth."
Yet, after being piloted for five years, from March 1999 to January 2004, the 12-bed Adolescent Centre for Treatment (ACT), was opened with great fanfare and hailed in the IWK 2003-04 annual report as the first step in the evolution of mental health care for Maritime children and youth.
According to the report: "Subsequent to the program’s launch, the team recognized a further need to expand clinical services. Not only did they see a need to expand ACT itself due to high demand for the service, but they also saw a need for an additional service to support youth after their experience in the program."
The 2008 provincial budget included $1.9 million to expand the ACT program. In October 2009, it was expanded to serve 18 youths, and a transition team was added, "allowing it to better help youth access quality mental health services and have stronger supports as they transition back to home," according to the IWK’s Report to the Community.
In its 2009-10 report, the IWK’s Susan Mercer, senior director mental health and addictions, boasted, "The IWK’s mental health and addictions program works in close collaboration with a number of care providers in the community for early identification and assessment. This ‘shared care’ model can provide better access to care for young people —- and save the health system time and money."
Where has the IWK’s mental health and addictions system gone wrong? Why are we now paying almost three times as much for no better access to care than was true in 2003? Where is all of that money going?
Why are they cutting back on the ACT and Compass programs when, according to the IWK’s own reports, these programs have proven their effectiveness?
I suggest the minister have an independent third party do an audit of the mental health services-delivery system at the IWK before any more costly major mistakes are made!
11 April 2012