Providence goes with outpatients

Providence Care Mental Health continues to cut beds, while prioritizing outpatient care

The new hospital will be built and maintained by a private consortium, in tandem with the Ontario government.
The new hospital will be built and maintained by a private consortium, in tandem with the Ontario government.
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Supplied
Providence Care Mental Health recently eliminated two wards and 60 full-time positions.
Providence Care Mental Health recently eliminated two wards and 60 full-time positions.
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In late 2013, Providence Mental Health Services announced a string of cuts to be implemented by the end of March — a reduction in the number of its beds, the removal of two wards and the elimination of 60 full-time positions.

Providence Care, which runs both St. Mary’s of the Lake Hospital and Providence Care Mental Health Services, announced at the time they’d cut beds to reach a target of 120. These beds will then be transferred into a new hospital set for completion in 2016.

The cuts to the hospital came as part of a $6 million reduction in funding from the provincial government.

Now, mental health patients are being sent home — for better or for worse.

Providence says fewer beds means shifting the focus from institutions to community support for mental health patients. Others are worried there aren’t enough resources in the community.

For some, it’s a déjà vu from more than half a century ago.

An increase in the availability of psychiatric medication in the 1950s saw psychiatric institutions across Canada either close or eliminate beds, sending thousands of patients back into their communities.

Unfortunately, many of these patients were discharged to a society lacking community support for those living with mental illness and found themselves impoverished or homeless after leaving hospital care.

One person concerned about similar consequences today is Dan Anderson, president of the Local 431 Division of the Ontario Public Service Employees Union (OPSEU). He feels community support right now is inadequate.

Anderson represents 525 employees at Providence Care Mental Health. He said the cuts at Providence Care are part of a preoccupation with cost-saving that doesn’t necessarily help patients.

“They’re looking for discounts on everything,” he said. “They have a formula. It’s close to what they have for nursing homes and general hospitals. They’ve taken that and applied it to mental health.”

The building that houses the Providence Care facility has been standing since 1959 across from St. Lawrence College. It replaced the Rockwood Insane Asylum as Kingston’s primary psychiatric hospital in the 1960s.

Located approximately 300 metres from the current hospital, Rockwood is no longer used, but it’s still owned by Providence Care.

Anderson said the community support in Kingston lacks qualified staff. He fears “ghettoization” of psychiatric patients, since discharged patients often end up living in low-quality housing complexes north of Princess St.

“What we’re doing is building large housing complexes in the north of the city,” he said. “When you turn around and have a large housing complex with mostly people with mental illness, it stigmatizes the area.”

Ontario Disability Support Program benefits haven’t kept up with inflation since the 1990s, according to Anderson, and many people with severe mental health problems rely on charities such as the Salvation Army and St. Vincent de Paul Society to survive.

The “fragmentation” of mental health services, he said, has resulted in a deficit of beds in psychiatric wards. This change is problematic when the population, and particularly the older population requiring geriatric care, is growing.

“I know jobs are going to go up and go down. But what about the clients?” Anderson said. “Reduction of beds is not in the best interest of the clients.”

Cuts, frozen wages and constant turnover at Providence Care have considerably degraded the morale at the hospital, he said, especially since there are already few people interested in working in psychiatric wards due to the stigma surrounding mental illness.

“A lot of staff have told me they don’t feel respected, they don’t feel valued,” he said. “When you have a workforce that feels that way, you’re not going to be able to retain them or get loyalty.”

Loss of funding has been a long time coming, however.

According to Karin Carmichael, a senior administrative director at Providence Care, the recent reductions have been in the works since Ontario Premier Mike Harris’ restructuring of the healthcare system in the 1990s.

Ontario’s Health Services Restructuring Commission issued the recommendations in 1998, she said, based on a formula that recommended a certain number of hospital beds per 100,000 people.

Upon taking control of the hospital from the Ontario government in 2001, Providence Care was legally obligated to continue with the cuts.

“When I first arrived at the hospital in 1984, we had 467 beds, and today we have 120,” Carmichael said. “So it’s been a slow evolution.”

According to Carmichael, as the focus shifts from inpatient to outpatient care, community services will receive more financial support for community treatment teams and new programs to help previous patients find employment and housing.

Providence Care, she said, has established a non-profit corporation to create employment opportunities. This Kingston-based corporation — Voices Opportunities Choice Employment Club (VOCEC) — runs food services, a car wash and print delivery services.

VOCEC provides patients with jobs at minimum wage, which then helps them gain work experience.

Carmichael believes the move towards community care has generally been healthier for patients, who gain more control over their own lives. “When beds close and people move out into the community, it’s not about becoming an outpatient,” she said. “It’s about becoming a citizen, and living in the community and contributing.”

Currently, many rooms in the psychiatric facility house multiple patients. At the new hospital, which will replace both the psychiatric hospital and St. Mary’s of the Lake Hospital on Union St., patients will have their own rooms.

Carmichael hopes the new facility will be more welcoming. She said the current building’s design has always been limiting, since it was never meant to be a psychiatric hospital.

The building used to focus more on keeping patients “locked away”, rather than rehabilitating them, she said, and offered little privacy.

“The physical structure that exists today was actually designed based on plans created prior to World War II, which was meant for a [turberculosis] sanatorium,” she said.

According to Dr. Stephen McNevin, outpatient care is almost always a much more desirable option than institutionalization for those suffering with mental illness.

McNevin works at the Personality Disorder Clinic, which offers specialized treatment to patients on an outpatient basis. The clinic is run by Providence Care, but it’s located in downtown Kingston rather than at the hospital.

McNevin said hospital beds and emergency care options will always be a necessity, but the current emphasis has shifted to offering mental health support in communities.

Patients typically spend about three days a week in the Personality Disorder Clinic and go through a series of highly-structured group sessions during each of those days.

It’s illogical to put people with personality disorders into hospitals, McNevin said, since it will likely worsen their symptoms.

According to the clinic, patients with personality disorders experience “intense, distorted thoughts and feelings” and engage in self-destructive, long-term behaviours that are difficult to change.

These patients are often impulsive and have a high likelihood of dying of suicide, McNevin said.

“When people come to the hospital, they lose their systems of support,” he said. “They’re often away from friends, relatives, families and they’re often pulled away from work.

“You keep people in a community, you keep them connected, and that speeds their recovery.”

McNevin said there’s a cost-saving element to the government’s plan, since community-based programs can be less expensive to maintain than inpatient hospital beds.

The intent is to match cuts to beds with equivalent or better services in the community, he said, such as having staff visit patients in their homes.

McNevin said Providence Care has welcomed patients from other institutions across the province for years, and the organization is now focusing on transferring these patients to community placements.

Depending on their needs, these patients will then either live on their own or have health specialists provide ongoing care for them in their residence.

“It’s been quite remarkable,” McNevin said. “Some of these people spent 30, 40, 50 years of their lives in an institution, and now, finally, they are placed into a community.”

Patients who are considered a danger to themselves or to others, however, will always be hospitalized. For example, the forensic ward in the new hospital will continue to house individuals considered not criminally responsible.

“That is jail. It’s supposed to be jail, because these people could be quite scary in the wider world,” he said. “But they’re trying to keep it in the least restrictive setting.”

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