Mental health services cut dramatically

by Cheryl Waugh

MANITOULIN --- Adult mental health services will be more difficult to access on Manitoulin after the board of the North East Mental Health Centre approved a plan to balance a $471,000 shortfall in adult community mental health programs.

The plan to balance the budget involves reducing community mental health services across the Manitoulin Sudbury Districts. On Manitoulin, the two staff currently employed to bring adult community mental health services to the Island will be reduced to 1.5 staff. The North East Mental Health Centre rents space at the Manitoulin Health Centre in Little Current, and has offices in Mindemoya and Gore Bay for its Island clients, which number between 120 and 150 people.

"Those most in need will still be able to access our services," said Diana Price, program manager for community and rehabilitation for the North East Mental Health Centre. "But, people can expect longer wait times now for service."

According to a press release from the North East Mental Health Centre (NEMHC), clients and families across the Manitoulin and Sudbury Districts can expect to wait up to 12 months for services, and some counselling and therapy interventions will not be available. Current wait times for these services are between two weeks and two months.

As well, seriously mentally ill clients requiring services from the Assertive Community Treatment Team could see wait times grow from one to two months to six to eight months, or longer. Seriously mentally ill clients in need of individual and group rehabilitation will have an increased wait time from one month to three or four months.

Clients and families will be required to travel to Sudbury for services or access service from an alternate provider. Office sites in East Algoma and Walden will be closed, as staff is relocated. Only minimal levels of services will be retained throughout the districts.

"The NEMHC board of directors is committed to quality mental health services, however, we must focus on balancing service demands with our fiscal reality," said Noella McNair, board chair.

Jean Trimnell, president and chief executive officer of the NEMHC, said it's critical that the Ministry of Health and Long-Term Care delivers on its commitment to mental health reform by appropriately funding community mental health programs.

"We are very concerned with the impact of service cuts to community mental health services and adult hospital based services," said Ms. Trimnell. "Achieving cost savings in the inpatient sector by reducing the need for hospitalization is highly dependent on the availability and effectiveness of community mental health programs."

According to a recent study undertaken by the Canadian Mental Health Association under-funding community mental health services has three consequences: overuse of more expensive health services such as emergency rooms and ambulances; inappropriate use of services that were never meant to service the mentally ill such as the police and jail system, and the tragedies of homelessness, victimization and suicide.

It's a known fact, said Ms. Trimnell, that people with mental illness are not getting the services they need, in large part because community mental health services have not had a base budget increase in more than 10 years.

"Two-thirds of our budget," added Ms. McNair, "has been flat-lined for almost 10 years. During that same time, inflation has raised the costs of everything that we do."

Compounding the problem is a recent OPSEU wage adjustment, called the "Bendel Award," which has increased the NEMHC's operating costs by $1.2 million.

"It's what has really impacted our budget," said Carol Philbin Jolette, director of communications for NEMHC. "We have wage increases of 13 percent over the next two years, which has created a huge deficit."

Overall, the NEMHC was facing a $2.3 million deficit on a total budget of $28 million. On March 26, in the first round of the budget approval process the NEMHC board tackled a deficit of $740,000. In doing so they cut children's services at the Regional Children's Psychiatric Centre, and in the Integrated Services for Northern Children and Pre-School Speech and Language programs. They also made cuts to the developmental clinical services, so children and adults with development delays can expect reduced access to some assessments, and behavioral therapy.

Fifteen full-time clinical staff and six part-time staff will be affected by the above cuts. As well administrative support will be reduced by two days per week, while the administration will be decreased by one full-time manager and one manager's work week will be reduced to four days.

The budget announcement prompted the Rainbow District School Board to lobby both the Minister of Education and the Minister of Health to intervene on the significant service cuts being made through the Northeast Mental Health Centre.

"We are gravely concerned about the issue of services being reduced for children and families," stated Jean Hanson, director of education for the Rainbow District School Board. "It is not a matter of where the affects will be felt, it simply would be bad for the children and families we deal with."

Quite clearly, the NEMHC is part of the continuum of support for students and families within the Rainbow District School Board area, said Dena Morrison, school board chair.  "The reductions the NEMHC board has announced recently will be a negative in regards to the achievement of children and families within our board," said Ms. Morrison. "I mean, if you're going to have children waiting much longer for help from a speech and language therapist, that will put those kids that much further behind."

Adult hospital based services will also be affected by the budget cuts. The plan approved by the board to address the $869,000 hospital deficit involves achieving an 80 percent occupancy rate by the end of the 2004-05 fiscal year. Reducing the occupancy rate to 80 percent equates to having nine unoccupied beds by the end of this fiscal year. The NEMHC is not reducing the number of beds available, instead they've developed a strategy to reduce bed occupancy, which involves improved care planning and achieving efficiencies in care delivery,  helping clients to access other more appropriate levels of care, and implementing a 'partial' hospitalization approach.

The NEMHC also will be cutting eight clinical staff and two clerical staff in the adult community mental health program, while the hospital based program will lose four clinical staff positions. That means the adult community mental health program for the entire area will have one part-time secretarial staff person to service 1,200 clients and the six remaining clinical staff.

That alone will contribute to longer waiting periods for clients, said Ms. Price. "Emergency rooms will likely see an increase in demand, and I'm sure there will be an impact on the police services as well. We were pre-skeleton to begin with."

There is some room for optimism. The effects of the board's decision will not be felt for another five months or so, as the board has to send written notice of its decision to the affected unions - OPSEU Local 666 and ONA Local 002 - which was issued on Monday, April 19. That begins the formal re-deployment process. According to an NEMHC press release, the delay in timing is to allow the parties to agree to an implementation plan. Implementation includes issuance of early retirement offers designed to generate vacancies to minimize lay-offs, to develop seniority lists to confirm affected staff and to generate bumping options to other jobs for those being laid-off.

It will also allow time for the provincial government to address the matter when they deliver their spring budget, which is expected some time in May.

The NEMHC board is sending a letter to the Ministry of Health and Long-Term Care which addresses the situation concerning the planned service cuts, and asking for an increase in operational funding to save the threatened programs.

"We feel optimistic that the Ministry's spring budget announcement will address funding and resource issues currently being experienced in community mental health," said Ms. McNair.

De-ba-jeh-mu-jig makes first overseas trip

by Michael Erskine

WIKWEMIKONG---The streets of Prague, the capital city of the Czech Republic, will feel the soft tread of Nanabush in May, or at least those of his modern chroniclers, as the De-ba-jeh-mu-jig Theatre Group sends a team to those distant shores as part of 'The Myths that Bind Us,' a three-way collaborative work between the University of Toronto, Debaj and Studio Epsilon.

The University of Toronto has been involved with the Czech group for a number of years, and thanks to a connection established with U of T professor Michael Schonberg during Debaj's stint last year as artists-in-residence at the Art Gallery of Ontario, De-ba-jeh-mu-jig has been invited to participate in this year's collaboration.

"De-ba-jeh-mu-jig has been established as one of Canada's premiere First Nation theatre troupes," said Joe Osawabine (Iktomi), the actor who plays the title role in the Trickster, and as of April 1, artistic director at De-ba-jeh-mu-jig. "The Czech group and the University of Toronto contacted us to take part this year."

Each year, theatre students at the two university programs work on a collaborative effort where the two teams each create a work based on a single theme, and then, the two groups integrate their work into a single production.

The theme of this year's production, 'The Myths that Bind Us,' is tailor-made for a three-way effort involving Debaj, whose experiences with the foundations of Native mythos span over a decade and-a-half.

Last November, Debaj began working with the U of T students to produce the Canadian mythology-based work.

On May 2, a seven-member contingent of Debaj personnel will make up a significant portion of the 25-member Canadian team flying to Prague for the first step in the artistic journey that will culminate in a new collaborative work, as the collaborators stitch the two creations together in a third unique piece.

This production will cover some significant new ground for the Manitoulin theatre group, and not all of it can be measured in air miles.

"This work has a very musical base," said Mr. Osawabine. "It's kind of neat to be working on something that is pretty much a musical."

There are a lot of challenges to be met in a collaborative work with a Czech group, and one of those challenges involves performing before audiences that do not understand the language in which the work is written, but that is also something with which the Debaj crew has some experience.

"In that way it is very similar to some of the things we have done in the past," agreed Mr. Osawabine. "We need to use a lot of body expression to communicate the message. Our audience over there will be largely Czech-speaking, and 'Trickster' is performed in English."

The Czech director of the combined piece has been shuttling back and forth working with both groups and familiarizing himself with the two works and three groups.

The language barrier has been partly ameliorated by the fact that Mr. Schonberg is fluent in both languages.

"The director will say something, Michael translates it, then he translates the answer back," said Mr. Osawabine. "He has quite a task to perform, but it all works out."

In fact, the physical challenges faced by the troupe in bringing 'A Trickster Tale' to Czech audiences may prove to be even more daunting than the language issues in the collaboration.

"For that production we have a number of props," he said. "The dilemma is we are limited to two suitcases apiece, so Billy (Shawanda, costume designer) and Peter (Jones, prop manager) really have their work cut out for them in sorting it all out."

The work Debaj is bringing with them to the Czech Republic requires some significant costuming, and where an actor's change of clothes meets the Trickster's masks and makeup, heavy negotiations can ensue.

After the Debaj and U of T crew return to Canada, they will host a visit from the Czech students and a series of performances of the collaborative work will take place in Toronto, Montreal, and Manitoulin.

 "There will be a 7 pm performance on June 5, 2004 at Pontiac School in Wikwemikong, that we have confirmed," said Mr. Osawabine. "There will also be a June 6 performance at a location to be announced, possibly Little Current."

Wikwemikong nursing program back on track

by Michael Erskine

WIKWEMIKONG---The unexpected closure by Health Canada of the Walk-in Nurses' Clinic last week took everyone by surprise, not least of which Chief Walter Manitowabi, who was taking advantage of the Easter long-weekend to get a short golfing holiday break from the rigors of office.

"It was certainly a shock when I got back," said Chief Manitowabi, who spent much of his first day back in the office sorting out what had happened to medical services in his community.

Chief Manitowabi discovered that a Zone Nursing Officer who was making a routine chart audit at the Health Centre in Wikwemikong on April 7, determined in the course of her assessment that the Wikwemikong nurses were providing services beyond what a strict interpretation of the regulations entitled them too.

"Basically, going into more medical services as opposed to preventive services," said Chief Manitowabi. "Because we are within 90 kilometers of a health facility with nursing and doctor services, our nurses are supposed to only be out in the community providing preventive services."

The regularly scheduled weekly visits by doctors and nurse practitioners were also a factor in the Health Canada decision to close the Walk-in Clinic on the afternoon of April 8, bare hours before the beginning of the Easter long weekend.

"Due to the size of our community (comprising by Chief Manitowabi's estimate some 60 percent of the Island's population), the amount of traffic going through our health centre, we have always been providing medical services," he noted. "The zone officer was unaware of that history, and shut down the facility until there could be a future investigation."

The decision came with virtually no warning.

"As far as I was concerned, it was a harsh decision," said Chief Manitowabi. "Some alternative measures should have been taken, rather than just closing it right down."

The Chief, along with health centre management and supervisors, huddled in conference throughout the Tuesday of April 13, putting together a list of the services they felt the institution should be able to continue to offer.

"Dr. (Ken) Barss, of the Little Current Medical Associates concurred with our list," said Chief Manitowabi. "That list was submitted to Health Canada."

There was no immediate response from Health Canada officials, so on Wednesday Chief Manitowabi got on the phone to discuss the issue with the Zone officer in question, and her supervisor. He was successful in negotiating the re-opening of the Nurses 'Walk-in Clinic by noon of April 14.

Under the terms of the temporary re-opening, the services will continue to be offered for a 30-day period.

"We have asked Health Canada staff to come to Wikwemikong to sit down and renegotiate our authority," said Chief Manitowabi. "A community of our size deserves no less. As for now, everything is essentially back to normal. We are hoping to meet with Health Canada to discuss the decision to close the clinic in the first place, and to put in place the advanced level of service we deserve."

Cambrian contacts advisory board

by Michael Erskine

MANITOULIN---Mariette McGregor-Sutherland, chair of the Manitoulin Cambrian College Advisory Board said she had been informed of a meeting being set up by the college for April 27, 2004.

Rumours that Cambrian College is scaling back its on-Island presence have been circulating through the community, despite assurances from College President Sylvia Barnard that no decisions have been made yet. Ms. Barnard gave assurances that the college would still maintain a presence on the Island, and that the college was simply assessing its delivery model. For all of those assurances however, the community remains largely in the dark as to what Cambrian College's ultimate plans for service delivery on Manitoulin will be.

"I really don't know anything," said Ms. McGregor Sutherland. "I asked if that was the earliest we could arrange a meeting and they said that was the best they could do."

Some changes have already taken place at the College's Little Current campus, with one position terminated at the end of March and another current full-time position directly moving to Espanola, where it will become a three-day position. The upgrading program currently run under the Manitoulin Tourism Association welcome centre on Highway 6 by the swing bridge is also slated to close, its program amalgamated into the Espanola program.

Cambrian College's current lease with the Town of Northeastern Manitoulin and the Islands apparently runs on a yearly basis, from September to September. Although no official contact has taken place between the town and the college to date, Cambrian officials are slated to meet with Mayor Joe Chapman next week, the same day on which the advisory council meeting has been scheduled.

"We haven't heard anything officially," said Manitoulin Secondary School guidance councillor and a member of the Manitoulin Advisory council, Leslie Marshall, "other than what we have read in the paper."

Without any official information, Ms. Marshall said it was not possible to assess how changes might impact the school.

What she could say however, is that it was very helpful to have 'Manitoulin people' available in Little Current in setting up the new program partnerships between the college and Manitoulin Secondary School.

"People like Judy Proulx, and others, have been very helpful with suggestions and input on programs," she said, noting that it would be hard to imagine things going as smoothly with people who were unfamiliar with the challenges facing the Island.

Ruby Croft holds an unique perspective as an Advisory Council member, as she is also the Mayor of Gore Bay.

"At least we are being called for a meeting now," said Ms. Croft, who said she was deeply disturbed by suggestions that Cambrian College was looking to discontinue the services they offer on the Island, particularly the upgrading offered in Little Current.

"How can we expect a client, who probably has transportation issues already, to get from Silverwater to Espanola?" she asked. "I am concerned that the 'consultative process' has already happened, and it didn't include the advisory council or the students."

Ms. Croft said that if the cutbacks in services prove to be true, then perhaps the Manitoulin Municipal Association should be involved.

"I hope that this meeting will at least provide some of the answers to a lot of questions," she said, adding that unofficially she knows some of the employees that have received layoff and reassignment notices. "Officially, it greatly disturbs me that the advisory committee did not know anything about this before things reached this point."