Mental health issues in York Region often overlooked: expert

Yorkregion.com
May 23, 2014
By Chris Traber

Mental illness has been defined as the orphan of health care.

Yet, it is underfunded and overwhelming for patients and practitioners, York Region’s front-line mental health administrators and physicians agree.

Part 1 of 6: The Long and Winding Road

Part 2 of 6: The Long and Winding Road

 According to 2011 census data, York Region had the fastest growing population of any region in Ontario, at 15.7 per cent, which means demand for mental health supports and services in the area will continue to increase.

Within a decade, seniors, who have a higher risk of dementia, will outnumber teenagers.

As more people seek treatment, mental health infrastructure remains relatively static.

Annually, York Support Services Network provides case management to about 1,000 people. Another 12,000 to 14,000 call the organization’s crisis line each year.

Demand for mental health services at our three hospitals grows exponentially.  

In 2011, for example, Southlake Regional Health Centre mental health-related visits rose by 19 per cent for children and adolescents and 5 per cent for adults.

The next year, Southlake’s mental health team treated 118,400 patients, including more than 4,000 people arriving at the emergency department in need of assistance and 96,800 on an outpatient basis.

The Canadian Mental Health Association York Regional Branch, working with just less than $9.5 million last year, served 1,752 individuals and more than 15,652 were reached through its health promotion and education programs.

The needs are growing and changing in our communities, CEO Rebecca Shields said.
 
There is an increasing recognition that there is no health without mental health, she said.

There is significant evidence mental illness is bereft of proper health parentage.

Nationally, mental health care receives a minuscule percentage of federal health dollars.

Of the association’s 2012-13 revenues, $8.5 million was provided by the Central Local Health Integration Network and Ontario Health and Long-Term Care Ministry.

The network, serving York and surrounding regions, allocated $72 million for outpatient mental health and addictions last year — about 4 per cent of its total health allotment.

Challenges abound, Ms Shields said.

A key impediment lies within individuals who have mental disorders.

“A lot of people are suffering, but, because of stigma, they don’t seek help,” she said.

If they do reach out, there are access issues and waiting lists, sometimes as long as nine to 12 months for a case worker to start a file.

York Region’s rural areas are under served, she said, and the burgeoning newcomer population will require increasing mental health supports.

One of the identified challenges experienced in Central LHIN is the gaps that exist in the mental health and addictions system and access to care, CEO Kim Baker said.

Other challenges include the availability of supportive housing, integration between the various sectors and support for primary care practitioners to treat patients struggling with mental illness or substance abuse issues.

“We are working with our 21 mental health and addiction agencies to address these challenges collaboratively, to harness best practices and innovation to improve care and to improve access to care with new funding when we can, she said.

The top three most common mental health issues at Southlake are people suicidal with depression, schizophrenia and other psychotic disorders and anxiety, mental health vice-president Annette Jones said.

In a region with more than 1.2 million people, hospitals are bracing for increased challenges. Resources for children and adolescent mental health care are scarce, said Ms Jones, who is also responsible for maternal child, medicine and surgery as chief nursing executive.

The health facility has only 24 adult mental health inpatient beds and the eating disorder program has two. She is hopeful the Central LHIN will soon fund an additional 12 beds.

The hospital admits about 1,000 patients each year.

Overflow patients often are put in queues, transferred to partner hospitals or supportive group homes that have a regional inventory of 746 beds.

“We’re facing unprecedented growth and demand for our services,” she said.

Optimistically, challenges represent opportunity to find solutions, Ms Jones said. Hospitals in York Region need to develop partnerships and pool resources with other health facilities, associations and organizations. Southlake is working to create a central bed registry with peer facilities, she said.

Markham Stouffville Hospital’s 33 adult mental health patient beds are perpetually occupied, chief of psychiatry Dr. Rustom Sethna said.

“We battle every day to ensure we can adequately service the mental health needs of patients,” he said.

“We do our best with limited resources.”

Mental health care professionals universally are frustrated with the bleak fiscal climate and trickle of budgetary dollars, he said. There are not enough front-line staff and case loads are bursting at the seams, Dr. Sethna added.

“All this makes it extremely challenging to provide high-quality care for a disorder that’s so isolating,” he said.

But it’s not all bad news.

There’s promise, he advised.

Robust pharmaceutical and therapy-based treatments are restoring many patients to a high-function life, he said.

Tele-medicine, remote assessment and treatment are on the horizon. Partial solutions exist by harnessing and co-ordinating community connectivity, he said.

“I think the multiple mental health agencies do the best they can with what they have,” he said. “The difficulty is they’re all so stressed. There’s no time to cross-pollinate with the organizations.”

Mental health specialists agree there is no immediate panacea for mental illness. They are unanimous in their advice to anyone suffering from a disorder.

“Reach out,” Ms Jones said.

There are supports available within the community and at Southlake. For example, there is a 24/7 crisis team available in the emergency department.

Ms Shields suggested being mindful of warning signs and risk factors by educating yourself on mental disorders.

“Break the stigma,” she said.

“Talk to your doctor. Get help.”

WHO IS AFFECTED:
 
• Mental illness indirectly affects all Canadians at some time through a family member, friend or colleague.
 
• 20 per cent of Canadians will personally experience a mental illness in their lifetime.
 
• Mental illness affects people of all ages, educational and income levels, and cultures.
 
• About 8 per cent of adults will experience major depression at some time in their lives.
 
• About 1 per cent of Canadians will experience bipolar disorder.

How common is it?

• Schizophrenia affects 1 per cent of the Canadian population.
 
• Anxiety disorders affect 5 per cent of the household population, causing mild to severe impairment.
 
• Suicide accounts for 24 per cent of all deaths among 15 to 24-year-olds and 16 per cent among 25 to 44-year-olds.
 
• Suicide is one of the leading causes of death in men and women from adolescence to middle age.
 
• The mortality rate due to suicide among men is four times the rate among women.

WHAT CAUSES IT:

• A complex interplay of genetic, biological, personality and environmental factors causes mental illnesses.
 
• Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem.
 
• Stigma or discrimination attached to mental illnesses presents a serious barrier, not only to diagnosis and treatment, but also to acceptance in the community.
 
• Mental illnesses can be treated effectively.

WHAT IS THE ECONOMIC COST?
 
• The economic cost of mental illnesses in Canada for the health care system was estimated to be at least $7.9 billion in 1998 – $4.7 billion in care and $3.2 billion in disability and early death.