The answer to Vancouver’s ‘mental health crisis’ – Alberta Hospital Edmonton

Building No. 9 at Alberta Hospital Edmonton.

When Alberta Health Services announced Friday it is “continuing the evolution of community-based mental health treatment in the province, and is accelerating its move away from a largely institution-based system,” many observers quickly concluded that the inevitable end result will be more mentally ill people dumped into the streets. Especially so, since the practical expression of this policy, AHS conceded, would be closing beds at Alberta Hospital Edmonton, a world class psychiatric institution.

The province-wide health board, of course, vehemently denied this. “I can tell you categorically that none of these patients is going to end up on the streets,” Dr. Patrick White, the AHS mental health services director, asserted in a media interview.

Others, such as physicians who run programs at Alberta Hospital Edmonton, Friends of Medicare, psychiatric social workers, unions and opposition politicians, insist that the consequences of this policy will be dire.

Whom to believe?

AHS, and the government whose policies it carries out, would like you to think all the people complaining about what it admits is a cost-saving policy are simply “the usual suspects,” people and groups who benefit from the situation as it is and whose oxen are about to be gored, or soft-headed “liberals” who have never seen a penny they wanted to pinch.

If you’re inclined to accept the official line on this, would you believe … the police?

Now, Alberta police forces are silent on this issue for the moment – although I’ll bet some individual police officers have pretty strong opinions on the plight of the mentally ill in our streets. However, a January 2008 report by Detective Fiona Wilson-Bates of the Vancouver Police Department makes some very interesting observations that are directly relevant to what is now happening in Alberta.

In Lost in Transition: How a Lack of Capacity in the Mental Heath System is Failing Vancouver’s Mentally Ill and Draining Police Resources, Det. Wilson-Bates provides some pretty blunt commentary on the reasons severely disturbed citizens are ill served by the system in B.C., and the impact of that situation on police resources and, ultimately, taxes.

It’s worth quoting from this report at some length, I think, and worth considering what the same policies have wrought in other jurisdictions where, for the same cost-saving reasons, governments have adopted a policy of “de-institutionalization.”

On the resource implications for the Vancouver Police, she writes: “Mental Health Act cases and and ‘disturbed person’ incidents alone required the equivalent of more than 11 full-time frontline police officers. Accordingly, the estimated direct annual cost associated strictly with Mental Health Act arrests and incidents coded as ‘disturbed persons’ would be at least $1.1 million.”

On the community facilities mentally ill patients were promised when B.C. psychiatric institutions were closed: “…Despite the promise of replacement facilities for the mentally ill in the wake of de-institutionalization, these beds have not materialized. Currently in Vancouver there are no treatment facilities to accommodate people who require a moderate to long stay (i.e., over three months). Moreover, there are no options for long-term care in the Lower Mainland. Compounding this is the fact that hospitals in Vancouver are simply not equipped to handle long-term psychiatric patients and primarily take a ‘crisis care’ approach.”

On the impact of the reduction in beds at psychiatric institutions: “…The reduction in beds at Riverview (psychiatric hospital) and the lack of support services in the community to replace those lost are significant contributing factors in the current crisis.”

On how police respond: “…The result is the criminalization of people who are mentally ill. When patrol members respond to reports of a person who is known to be mentally ill screaming obscenities and being physically aggressive with pedestrians, they are more inclined to take the offender to jail in the absence of reasonable access to mental health services.”

On the overall effect of this situation: “It is clear that many Vancouverites with mental health issues are poorly served by a system that is failing. VPD officers, along with the mentally ill citizens with whom they come in contact, are bearing the burden of a mental health system that lacks sufficient and effective resources and adequate information sharing, often with tragic consequences.”

Now, that’s just in Vancouver, of course. But ask yourselves, Albertans: Do you really think it’ll be any different here?

There’s more to Det. Wilson-Bates’s report, of course, and it’s well worth reading. In her conclusion, she makes some recommendations about how the situation might be fixed. No. 1 on her list of “what’s needed” is as follows: “A mental health care facility that can accommodate moderate to long-term stays for individuals who are chronically mentally ill.”

You know, just like Alberta Hospital Edmonton.

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