Mental health care: change is urgent
Gaps in Nova Scotia’s mental health care have rightly received a lot of public attention. We’ve heard stories of people who have suffered or died while trying to access timely care. We’ve heard calls for improvements from care providers. We’ve had critiques of system-wide problems from the province’s auditor general.
All reinforce the troubling message that our mental health care is not what it should be, is not well planned, nor consistently delivered nor improving quickly enough.
What does it take to make a breakthrough in care that costs Nova Scotians $225 million annually and that 20 per cent of us will need in any given year?
The stories of two women have recently been publicized. Fran Morrison and Laurel Walker, who have created a Facebook group #HOWMANYNSHAIWK to push for a more client-centred system that doesn’t leave people waiting so long for care and put at greater risk by feelings of isolation and desperation as they wait.
Both have lived the tragedy of losing someone to suicide. For Ms. Morrison it was her 21-year-old son, Eric, six years ago. For Ms. Walker it was a woman she helped as a peer counsellor. In both cases, they believe the system failed a very sick person by ruling out in-patient care and not providing a timely, effective alternative.
Their message is consistent with a November report on mental health services by Auditor General Michael Pickup. He generally gave the IWK good marks for planning and service. But for the system in general he “found there were no overall service delivery plans in place, a model of care that was implemented haphazardly across the province, inconsistent policies covering crisis response service provision, and inadequate accountability for program funding and delivery.”
Mr. Pickup said psychiatry support for ERS was inconsistent, with the fourth busiest ER, Dartmouth General, having none at all. Staff there rightly felt the system “is not patientfocused.” He says the health authority should assess crisis and psychiatry services at ERS and “consider costbenefit, patient-focus, and alternative service delivery models to increase availability if required.”
Starting at the IWK, there has been an effort to adopt a patient-focused alternative model, the Choice and Partnership Approach (CAPA). Pioneered in the U.K., CAPA provides patients an early collaborative meeting with a facilitator to map out a plan with a schedule of appointments with clinicians or other services the patient agrees are appropriate. But Mr. Pickup says CAPA has been inconsistently implemented and not well evaluated.
So Fran Morrison and Laurel Walker are right to press for much more rigorous change from the new director of mental health and addictions services the health authority will appoint this spring. A CBC story on their site raises one possibility in relating the success of a walk-in counselling clinic in Kitchener-waterloo. Mr. Pickup identifies a successful collaboration by psychiatrists to support ERS and clinicians in northern Nova Scotia. A better rollout of CAPA is needed. For those who are waiting too long for help, the need to make such service changes is urgent.