The Folly of The First York Region Ontario Mental Health & Addictions Crisis Hub


By Dr David Laing Dawson

Background

incredibly unique and innovative”

It will serve ages 12 and up, with 20 beds for those 16 and older — 10 for crisis stabilization and 10 for withdrawal management.

Individuals in crisis will be triaged and offered addiction support, rapid access to addiction medication and mental health support.

There will be a 24/7 physician on site and eight hours each day access to psychiatrists.

This, of course is not just a waste of time and money but a disaster waiting to happen.

I have spent sufficient time in committee meetings, community consultations, planning meetings, and strategic planning meetings to understand how such a project gets a green light:

It’s the words. The buzz words. The virtuous words. The words no one can argue with: Innovative, inclusive, support, unique, hope, incredibly unique, rapid access, 20 crisis beds, holistic, triage, 24/7, withdrawal management, crisis stabilization.

The words, at those levels of planning, become the reality. And few at those committee and planning tables have the experience and ability to actually imagine how such a creation will play out with real humans in real time.

Well, they are really creating a very expensive small independent hospital, presumably with outpatient services, 10 “beds” for addiction withdrawal, 10 “beds” for something they call “crisis stabilization”.

Let’s look at the “crisis stabilization” part first. What on earth is that? Who are the people with mental illnesses who will avail themselves of or be taken to this facility?

People with serious mental illnesses, untreated, become psychotic, manic, delusional, depressed, disorganized, distrustful, and sometimes, violent. They also may, while very ill, develop other life threatening illnesses.

At that moment in time, voluntarily attending, or brought by police or family, they need to find themselves in a safe place, with adequate security, and sufficient medical and nursing resources and investigative tools, to deal with any serious medical illnesses or concerns (head injury, pneumonia, infections, metabolite problems, kidney failure, drug reactions…) and have the treatment facilities and personnel equipped to provide emergency treatment for psychosis. (this means, by the way, a well equipped pharmacy on hand, blood work, xray, and CTscans). In other words, the resources of a hospital.

Some of these patients/clients/people will allow themselves to be talked into staying, at least for the night. Others will refuse and will need, if deemed a danger to themselves and/or others (in crisis), involuntary admission and treatment. They will need a schedule 1 facility, a designation which a stand alone 10 bed facility is unlikely to be given.

Will this 10 bed facility be locked? Will clothes be taken away? Searched for drugs or weapons?

Such an isolated 10 bed facility cannot investigate, diagnose, treat, keep safe someone in the throes of psychosis.

So who will they serve with those ten beds? Likely someone needing a bed, and three meals, for the night or week during a cold spell in the winter. Fair enough. But this then is a very expensive motel.

And if seriously mentally ill people are admitted to those 10 beds, they will need adequate around the clock staffing (five full time nurses are required to provide 1 nurse 24/7), medications on hand, a psychiatrist on call, sufficient staff and security for that one night nurse to feel safe and in some control. And easy and safe access to other services and resources if a life threatening crisis occurs during the night. Who will respond to a code white?

And then we have, presumably within the same ward, 10 beds for withdrawal management. This would serve, presumably, addicts who have decided to voluntarily go through the process of withdrawal. Doors will not be locked.

Now withdrawal from a serious addiction involves three aspects: medical management of potentially serious medical problems as they arise: from tremor to delirium to pain, anxiety, paranoia, seizures, to kidney and heart failure.

The second aspect of successful withdrawal is vigilance/persuasion preventing the patient from acquiring drugs.

The third is alleviating some of the withdrawal symptoms by prescribing other addictive, though prescribed and thus controlled, and presumably less harmful, substances.

A stand alone 10 bed addiction treatment facility is more likely to function as intended than a stand alone 10 bed mental illness treatment facility. Either way, they are not compatible, and should not be placed under the one roof. Violence will occur; nurses will loose their compassion for the mentally ill; and the dealers will come to visit their customers in the parking lot behind the facility.

Though only a 20 bed facility it will have to have the same infrastructure as a full hospital: board of directors, CEO, managers, Departments, finance department, Personnel department, unions, medical record department, insurance, legal support, food and hotel services, infection control………

Would it not make more sense to take the substantial amount of money required for bricks and mortar and operating costs of this “Hub”, and give it to the local hospitals with the condition that they use it to expand their psychiatric wards, addiction treatment facilities, mental illness and addiction emergency services, and social services?



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