Doctors oppose plan to close beds at Alberta Hospital
By Archie Mclean, Edmonton JournalAugust 18, 2009Comments (27)
Four psychiatrists at Alberta Hospital Edmonton are worried their mentally ill patients will end up on the streets or in jail if the province goes ahead with plans to close beds.
They said Monday the government is moving too quickly with plans to close 100 to 150 beds and hasn't properly consulted with caregivers and experts at the hospital.
"What motivates us out here is safe, proper, compassionate care for our patients," said Dr. Kevin Lawless, who works in the geriatric division. "If we can't respond as health-care providers, then these individuals may end up being redirected into jails and prisons."
Dr. Krista Leicht, who runs a provincewide program for developmentally handicapped people with psychiatric problems, said the former hospital patients "may also end up living in the inner city, on the streets. We're very fearful for the safety of our patients."
The doctors were reacting to an announcement Friday that the government is scrapping plans to redevelop the hospital and will eliminate the beds over the next one to three years.
Dr. Patrick White, the director of addiction and mental health at Alberta Health Services, said any money saved by not redeveloping the facility will be put into community care.
"I can tell you categorically that none of these patients are going to end up on the streets. These patients will be moving to appropriate accommodation in the community, otherwise they won't be moving at all."
Leicht and Lawless as well as Dr. Alberto Choy and Dr. Andrea Gambetti said they first heard the news early last week, but were assured they would have input into further decisions. That was the last they heard until the government made its announcement.
"We're a little shell-shocked," Lawless said.
While they all agree community care is important, it's not a substitute for acute-care beds. Clinical teams at the hospital move people into the community all the time, but when a patient is in a crisis, hospitalization is the only option.
"For the specialized programs we run here, we need the backup of these acute-care beds," Leicht said. "We all have huge wait lists, so we could probably make the argument that we need more beds."
They also expressed concern about the process leading up to the announcement. The government is wasting decades of expertise in mental health by not consulting them, they said.
Gambetti said similar scenarios have played out in other jurisdictions. Doctors are told resources will follow their patients into the community, but it never happens.
"This has led to increased criminalization of the mentally ill and the movement away from institutions, but toward what you could call mental-health ghettos in the inner city," Gambetti said.
Don Stewart, a spokesman with Alberta Health Services, said doctors will be a part of future consultations.
Stewart added that a patient's health and safety will be the most important consideration when deciding the type of care.
But Dave Eggen, the executive director of Friends of Medicare, said the doctors' concerns should carry more weight in decision-making.
"It's deeply cynical to make wholesale changes to mental health without consulting the professionals who provide that care."
The government is facing a $1.1-billion shortfall in health care, and Eggen and others say the move at Alberta Hospital is little more than a funding cut.
A nurse familiar with community care at Alberta Hospital also echoed the doctors' concerns. She said community support is not a substitute for hospital care, and accused the government of preying on society's weakest.
"These are the vulnerable, these are the people who can't speak up for themselves, people (the government) wishes didn't exist," said the nurse, who didn't want her name published because of Alberta Health Services' rules against her speaking publicly.
Even before Friday's announcement, Alberta had far fewer psychiatric beds than the national average.
A government-commissioned report by McDermott Consulting, which was leaked last spring to the Alberta NDP, found that in 2005 the province had about a quarter the national average of psychiatric beds.
Alberta Hospital currently has about 400 beds in total, roughly 120 of which are in the forensic section for people who are ordered by the courts to be there.
Austin Mardon, a local Order of Canada recipient who has schizophrenia, said people with chronic mental illness need hospital beds to "reboot" from time to time.
If the government does cut acute-care beds, it will be short-sighted, because preserving them could mean long-term savings in AISH (Assured Income for the Severely Handicapped), the criminal justice system and elsewhere.
"Mental health is always the orphan child of the health-care system."
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