I am writing in regard to the May 26 article “Capital Health prepares for strike." In anticipation of a nursing strike, Kathy Mac-Neil, a vice-president with Capital District Health Authority, was quoted as saying that “life and limb" emergencies would not be turned away, but in areas such as mental health, the authority would “probably restrict those to emergency admissions only." What a joke!
Ms. MacNeil has obviously never tried to access mental health services for a friend or family member in Nova Scotia.
As everyone who has ever tried to do so is painfully aware, there is no way to get timely access to mental health services in our province other than in an emergency situation. In order to access even remotely timely services, people have to be considered an immediate danger to themselves or others.
Even if a mental health professional thinks someone may become a danger to self or others if their condition deteriorates, that is not reason enough to be provided with immediate help, according to the provincial Mental Health Standards adopted by the province in 2009. According to these standards, there are four levels of urgency to be considered in the acceptable wait times. Level 0 is classified as “emergent." In those cases, a person must be an “immediate and significant risk of harm to self or others" or have “acute psychosis or mania which cannot be managed in the community." The examples given in the standards are “acute suicidal thoughts with intent," “acute psychosis" or “acute mania." In these cases, the referral process is to send the person to a local emergency department if it’s open.
Level 1 is classified as “urgent." In this category, the target wait time is a week. In this case, the person should be a current risk to self or others, but judged “safe" provided treatment is made available within the next seven days. This person should have “escalating psychosis or mania with a risk of rapid deterioration and need for hospitalization within a week or two."
Examples are “acute suicidal thoughts," “mania," “hypo-mania" or “psychosis."
The Level 2 classification is considered “semi-urgent" with acceptable wait times of a month. These people can be “unstable with risk of acute decompensation due to unstable illness, personality or circumstances." They can be “engaging in new or increased risk behaviours due to mental illness," and there can be “acute deterioration in functioning and role performance due to mental illness." According to the Mental Health Standards of Nova Scotia, it’s totally acceptable to let these people wait 30 days for help.
Also deemed to not require treatment for up to 30 days are people who have “acute clinical depression." They can be “depressed with suicidal thoughts but no intent, plan or history of suicidal behaviour." They can be “single parents with no supports and unable to care for children due to depression." For these people, a month’s wait is acceptable, but according to the standards, a referral to Child Protection Services should be made.
Also falling into this category are parents with mental illnesses suspected of neglecting their children. According to the standards, it is appropriate to leave these people waiting for help up to 30 days!
Finally, we have Level 3, which is considered “regular."
These people are left waiting for services for up to three months or more. People who fall into this category are “chronic but stable patients where rapid deterioration is not imminent in the short term." These are people who are suffering from “depression, anxiety, anger problems, coping problems or personality disorders." They are expected to wait up to 90 days for help if the standards were being met. However, they are not!
In June of 2010, the Nova Scotia auditor general released his report of an investigation into the province’s mental health services system. He found that these standards, as lax as they are, are not being met more than 85 per cent of the time. He also said there was no plan by the Department of Health and Wellness to fix this situation.
I contend, and I expect most Nova Scotians would agree with me, that this is a completely unacceptable situation.
In its 2010-2011 Statement of Mandate, the Department of Health and Wellness made a commitment to “develop a plan to measure wait times." The “strategies to achieve (this) target" were to “continue to implement collaborative primary health teams providing services to mental health patients" and to “host an Atlantic Mental Health Summit to consider collaborative policy initiatives among key stakeholders." While the department is developing “a plan to measure wait times," people who are waiting for mental health services are committing suicide, suffering with their illnesses, creating untold hardship for themselves and their families, and giving up hope.
I am not talking about one or two per cent of the population here, but approximately 180,000 Nova Scotians. Whether or not Capital Health District nurses strike, while professionals sip coffee and listen to keynote speakers at the Atlantic Mental Health Summit, people suffering with mental illnesses will be waiting in vain for help.
John Roswell is program co-ordinator, Digby Clare Mental Health Volunteers (dcmhv@hotmail.com).
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