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Patients harmed by mental health revolving door, watchdog says

Hundreds of mentally ill and addicted patients are still showing up in Alberta’s emergency wards at least 10 times a year, including one person who visited on 98 separate occasions during a recent 12-month period.

One-fifth of the province’s psychiatric beds are filled with people awaiting discharge to a suitable placement in the community.

Half of the Alberta’s 42 primary-care networks still have no mental-health workers to help those suffering from depression or other disorders.

Community clinics are so busy that new patients are still forced to wait a month on average to get into counselling programs, and sometimes the delay before they speak to a therapist can be longer than three months.

More than a decade after the government unveiled a new plan and four years after it produced another new strategy to transform the system, auditor general Merwan Saher says in a new report that the province’s health authority has largely failed to deliver on the promise to deliver mental health care focused on patients, so that some of society’s most stigmatized stop falling through the cracks.

“We don’t need a new strategy, we just need people taking action,” Saher said in an interview.

“Progress has been slow and sometimes non-existent because there is this sense among Alberta Health Services managers that their hands are tied behind their backs.”

But Alberta’s financial watchdog is emphatic that the authority’s bureaucrats have all the authority they need to ensure care for the mentally ill is better co-ordinated, including placement in suitable housing and provision of home care the mentally ill need to live productively and stay out of the province’s acute-care system.

As it stands now, AHS reports show one in five patients relapse within a month after release from hospital and end up back in the emergency ward. Half of those are readmitted.

“This revolving door cycle harms the patient, wastes resources and is extremely demoralizing to the front-line health-care providers,” Saher writes in his report.

“AHS cannot afford to take a passive role on community housing supports for people with mental illness.”

The report is also sharply critical of the lack of information sharing among the “operational silos” at clinics, substance-abuse programs, doctors’ offices and hospitals.

While AHS has said it is considering spending $1 billion on a unified clinical information system that would take five to 10 years to introduce, Saher said there is much more the authority could be doing right now.

For example, mental health workers and addictions counsellors who now work alongside one another at the health authority do not have access to each other’s information systems, even though half of all people with mental illness also have a concurrent drug or alcohol addiction.

“Five to 10 years is too long for someone with an existing chronic disease to wait,” Saher said.

Health Minister Sarah Hoffman said the NDP government will commit additional dollars to the $750 million now spent each year for mental health and addictions care, but there will be no consequences for AHS bureaucrats for the failures identified by the auditor general.

“It’s heartbreaking, but I’m not surprised,” Hoffman said.

“Who’s to blame in the past is not going to help solve problems in the future.”

David Grauwiler, provincial executive director with the Canadian Mental Health Association, said he’s concerned Saher’s report repeats much of the same criticism the auditor general’s office directed at the mental health system seven years ago.

“It’s incredibly disappointing when you consider that one in five Albertans is impacted by mental illness at some point during their lifetime,” Grauwiler said.

“There’s some big question marks as to why this hasn’t been a higher priority.”

Vicki Kaminski, AHS’ chief executive, was not available to be interviewed.