Sunday, November 10, 2002

Mental Health in Peril: Saving the Royal Ottawa

When I am introduced to someone it is usually as a composer, a writer, and a poet. Presently I am also on the board of directors of a new music society that presents concerts of contemporary classical music, and am the new Music Director of that organization. What usually doesn't come up in a conversation is that I also have an illness that I have been living with for about 19 years, and which has profoundly affected my daily living, and my ability to effectively interact with people, sometimes forcing me into a self-imposed exile to prevent the symptoms from overtaking me completely. I am speaking of bipolar affective disorder, otherwise known as manic depression. In essence, I am a crazy composer. Historically speaking, many far greater creative minds than mine have also been afflicted with this illness, including the likes of Robert Schumann, and Hector Berlioz, not to mention writers like Lord Byron and Sylvia Plath.

You may think it odd that someone would willingly admit that they have a mental illness, and in a sense, you would be correct: "normal" people don't want to talk about these things, and that is a serious problem. Mental illness, and consequently mental health has remained a marginalized: it is a ghettoized health concern and when it rears its ugly head it is turned into the "dirty little secret" that nobody wants to face. Unfortunately the world in which we live is making that attitude more difficult to maintain: while many are trying to cope with these illnesses and remain working, more people are ending up on medical leave for extended periods of time as they succumb to depression, manic depression, or one of the other illnesses that can become so overwhelming it becomes impossible to work. Mental illness has been described as the fastest growing cause of disability in the world by the World Health Organization, which reported in 2001 that of the people aged 15-44 who were classified as living a "disability-adjusted life" 20.6% had a form of mental illness. This compared to 13% who were living with HIV/AIDS.

Manic depression is a disease that can steal your life. I have found it exceedingly difficult to interact with other people, virtually impossible to work in the "real world", and it has placed tremendous strains on interpersonal relationships. While it is possible for me, as someone living with this illness, to understand how it affects my life, it doesn't change the fact that I don't always have the control over my emotions that I would like. Fortunately for me I do not experience full-blown mania, but I do cycle very rapidly which can be very difficult to cope with: from one moment to the next my mood can go from feeling quite elated, almost euphoric, to a melancholic depression that leaves me feeling like I want to die. If a disease is to be classified as serious because of the potentiality of death, then you should know this one thing about manic depression: this is a potentially fatal illness that will get worse if left untreated. Twenty-Five percent of those afflicted with this disease will die by their own hand over the course of the illness. Suicides will often take place as a period of depression is ending, when things are looking less hopeless and there seems to be less cause for concern. This is where mental health workers come in, because we simply cannot make it on our own.

There are many hospitals that will treat you well if you become ill in Ottawa: the Heart Institute is renowned for its quality of care, and CHEO is similarly celebrated for its caring staff and dedication to their young patients. But there is only one hospital that is singularly dedicated to the treatment of mental illness: the Royal Ottawa Hospital. The Royal Ottawa Hospital is where you want to go if you need help with a mental illness. The ROH cannot be replaced by any of the other hospitals in the area as it is staffed by professionals who only deal with patients with mental illnesses, and the people who are a part of their lives. The ROH is also involved in undertaking cutting edge research into the causes of mental illness, and it was a doctor at the hospital who was a part of the team that discovered the so-called "suicide gene" which was widely reported and will hopefully lead to new, more effective treatments of depression. But more important than any of that, the staff at the Royal Ottawa are in the business of helping people put broken lives back together, healing wounds that cannot easily be seen on the outside and preventing new wounds from being opened. In a very real way, these people save lives, just as much as a heart surgeon who performs a life-saving procedure: I have no doubt that without the caring, decent people, with whom my care has been entrusted to at this irreplaceable institution, I would not be in a position to write this — or anything else for that matter.

But that is not the whole story.

Several weeks ago it was announced that it might be necessary to lay-off up to seventy members of the Royal Ottawa staff and cut some of the services provided. This was in response to an operational deficit faced by the hospital and the new law by the government of Ontario making it illegal for hospitals to operate in such a position. The truth behind the shortfall, however, has much more to do with government badgering than fiscal irresponsibility. The government of Ontario ordered the ROH to restructure: the absorption of the Brockville Psychiatric Unit and the transference of the emergency services unit from the ROH to the Ottawa Hospital are just part of that restructuring. With the restructuring came a commitment from the Ministry of Health to cover the costs of the process, otherwise the ROH would not have chosen to undertake the horrendous expenses on their own, and why should they?

When faced with a similar scenario the Board of Directors of the Ottawa Hospital refused to cut any of their staff. Many positions were eliminated with attrition, but services were preserved. However, the Board of the Royal Ottawa seems incapable of guiding the hospital through this troubled time: instead of lay-offs the hospital would be better suited by their removal and the installation of a new board that is willing to fight for the quality of care that was provided in the past and improving upon it, not letting it degrade with unnecessary cuts. The one thing that politicians and administrators fail to understand when it comes to the provision of health care is that publicly funded care is not, nor should it be considered, a for-profit industry. The "health industry" is one which we must invest money into rather than cutting funds from if there is to be any hope of preserving the quality of care that we have today without risking severe degradations of service.

There seems to be a distorted sense of value when it comes to the treatment of mental illness. If this reduction of services is allowed to take place, for example, there is a very real possibility that some of the people needing the expertise offered by the staff of the ROH will not be able to receive that care. In the long run, this can result in more expense to the health system as some conditions becoming more serious to the point that more expensive, in-patient hospital stays will be required. The worse-case scenario, of course, is much worse: a person who is unable to receive the help they need may make a decision out of desperation, choosing to end their life, thus becoming another statistic. This is the real human tragedy that the provincial government is contributing to in their failure to provide the necessary funds in order to prevent the cuts in services.

It has been asserted by the administration of the Royal Ottawa that the cutting of seventy staff members will not have a negative affect on the services provided. This is ludicrous: the people who have been targeted for these cuts are already carrying inordinately heavy work loads. Nurses, occupational therapists, psychologists and social workers are carrying combined caseloads of both inpatients and outpatients that could often be covered by two full-time positions, but instead, one person bears all of the responsibilities, as well as running whatever groups they may be committed to. Even if one position is eliminated it will mean that a heavier workload will result for the remaining members of that particular health-care team, putting the health and life of patients at risk.

It is time for us to put our priorities in order, understanding that mental health care and the treatment of mental illness is an investment in people worth far more than any amount that is put into it. If we allow the government to force our hospitals to select a course contrary to that which they would have taken and then force them to pay for the misguided restructuring with the people who are there to provide care for the ill, then we are doomed to see our health care system collapse under the incompetence of the administrators currently running the province. The people who work at the Royal Ottawa Hospital need to be saved from this "hacking and slashing" mentality of fiscal responsibility. We need this hospital, with all of its staff, not some "Royal Ottawa Lite" that takes a step backwards in mental health care. That is a price none of us can afford to pay.