Saturday, August 14, 2010

Scandalous neglect of the mentally ill

The London Free Press
By Rory Leishman

We Canadians like to think of ourselves as an especially compassionate people, but you would never know it from the way so many of our fellow Canadians with a severe mental illness have been shamefully neglected.
Following the development of anti-psychotic drugs in the 1950s, Canada followed the lead of the United States in the mass eviction of patients from psychiatric hospitals. The intent was both to save billions of dollars in hospital expenditures and improve the lifestyle of these patients, by empowering them to live productively in the community.
The first of these aims has been amply achieved, but not the second. To this day, tens of thousands of Canadians with a severe mental illness have been abandoned in the community without adequate psychiatric care. Many go off their medications and get in trouble with the law. Countless others languish in dingy and noxious flophouses.
Granted, mental patients who have been diagnosed as a danger to themselves or others can still be hospitalized. And Canada is blessed with many outstanding psychiatrists who have dedicated their lives and careers to helping these severely ill and often demanding psychiatric patients.
However, there simply are not enough of these committed psychiatrists to meet the need. To some extent, that is understandable. The marvel is that so many psychiatrists are willing to get up in the middle of the night to help deal with some deranged psychotic who has gone berserk on an acute-care mental ward when they could live a much quieter and easier life counselling the “worried well” from nine-to-five in a cozy office.
In 2004, the Ontario Ministry of Health undertook to improve acute psychiatric services, by providing the London Health Sciences Centre and other eligible hospitals with millions of dollars in additional annual funding “to enhance the remuneration of physicians providing psychiatric services in hospitals and to attract psychiatrists to work in hospitals.” In a contractual agreement with hospital administrators, the Ministry specified: “Please note that this funding is to be directed towards the payment for physician psychiatric services.”
Last October, 12 psychiatrists employed by the LHSC sent a letter to David Caplan, then Ontario Minister of Health, stating their belief that the extra money given to their hospital under this 2004 agreement to increase their stipends for psychiatric services had been misallocated. Copies of the letter were also sent to the Ontario Attorney General and Auditor General.
Having received no response, the 12 physicians sent a follow-up letter on February 26 to the current Ontario Minister of Health Deb Matthews, Liberal MPP for London North Centre. An official investigation is now underway. According to legal counsel for the Ontario Attorney General, the health ministry has commissioned PriceWaterhouseCoopers LLP to conduct “an audit of the Psychiatric Stipend funding allotment provided to LHSC to ascertain compliance with the eligibility criteria and the other terms and conditions of the funding.”
Matthews should make the results of this audit public. And if the allegations of the 12 psychiatrists are substantiated, she should undertake to assure that the hospital administrators responsible for the misallocation of enhanced funding for the provision of acute-care psychiatric services are justly censured.
Alas, the allegations of administrative malfeasance in this instance are not unique. There have been numerous other complaints about maladministration within London Mental Health Hospital Services. In an ongoing law suit, another psychiatrist, Dr. Gamel Sadek, charges that agents of St. Joseph’s Health Care London wrongfully ended his employment at the hospital and engaged in a “malicious and vindictive attempt” to embarrass and discredit him “in the event he ‘blew the whistle” on their deliberate mismanagement of the psychiatric care program, and the mishandling of doctors, forcing a mass exodus.”
Sadek’s allegations have not been proven in court.
Matthews can be counted upon to monitor the Sadek case closely. She deserves strong public support in all her efforts to assure adequate administrative and financial support for all the dedicated psychiatrists who care for many of the sickest and neediest of our fellow Canadians.

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