The Decline of Psychiatry, Part 4

While people are in shock and horror at the decline of psychiatric services, this is all part of a larger picture where

• the psychs that do exist are moving to big cities where they can charge more and make more money
• Battered over the years, there are less people going into psychiatry as a profession.
• As soon as the organic disease process is identified, the claim of psychiatry is largely undermined and it passes instead to neurology or another specialty.

Of course, there have also been problems of compassion within the mental health industry as well, as evidenced by profiteering, etc.

From the Nanaimo Daily News

There may some logic, based on crunching numbers and bureaucratic mumbo jumbo, in the decision by the Vancouver Island Health Authority to close the psychiatric unit at West Coast General Hospital in Port Alberni, but the closure makes no sense.

VIHA said they had to shut the unit for as long as a year because they cannot find a replacement for a departing psychiatrist. It's hard to believe that VIHA has allowed itself to end up in this position.

In fact, Alberni-Qualicum MLA Scott Fraser is right when he says, "It's not acceptable . . . . It's not an option. You cannot shut down essential services."

To add to Fraser's incredulity, closing a mental health ward approaches irresponsible if not outright negligent.

VIHA might argue they have no control over the comings and goings of doctors, but it's pretty hard to believe that they did not or could not foresee this long enough ago to take appropriate action.

Either way, the fact that they could not negotiate to have the current psychiatrist remain until a replacement could be found, or that they were caught by surprise, indicates something is wrong within VIHA.

What this also seems to indicate is that the health authority has little regard for those in need of mental health care.

Imagine if VIHA allowed the same state of affairs to happen at an emergency ward. The province would have to step in, replacing the VIHA board of directors -- who may also be personally liable for any tragedy -- and take steps to make sure that mandated level of emergency care is in place.

It is pretty shocking when one considers how the VIHA brass in Victoria seem to think about the mentally ill. The need for a psychiatrist in any community has to be seen as crucial as an emergency ward.

What the health authority seems to be saying is that someone in Port Alberni, or anywhere in the VIHA jurisdiction for that matter, who arrives at a hospital with a psychiatric crisis counts less than someone with a broken arm.

Sure, an untreated broken arm can lead to gangrene and death. But untreated mental distress can lead to suicide. And just as time is crucial in treating a medical emergency, so it is with a person in crisis from a mental disorder. Leaving such a person without necessary help will lead to escalating behaviour which can be violent or self destructive.

One agency that will not be very happy with state of affairs will be the RCMP. They are the ones who will have to cope with violent or suicidal people until appropriate help can be found. What do the RCMP do? Drive them to Nanaimo Regional General Hospital? Keep them in jail and let the courts sort it out?

VIHA's plan is that mental health and addictions community office in Port Alberni will handle psychiatric patients. The folks in that office must be just thrilled that their bosses in Victoria, who appear to have no insight into the needs of a person in mental distress, have delegated them as the ad hoc psych unit for the city.

The other plan is that a community response team will also intervene for people in need of psychiatric care. One problem though is that the team has not been established.

It's rather puzzling that VIHA appears to be able to put together this idea of a community response team, but can't seem to hire a psychiatrist.

Since its inception in 2002 VIHA has failed to serve any community on the Island adequately. Hospitals have become dirtier and less efficient, staff are overworked like never before, health facilities are increasingly crowded and this episode in Port Alberni is evidence of gross mismanagement.

The one place to start for a solution is for the VIHA board to censure Howard Waldner and his management team. And given that the board is ultimately liable, it seems they need to send a message that this state of affairs cannot go on.