The future of mental health care in St. Thomas-Elgin is the thin edge of the wedge

Proposed funding cuts in Elgin county are the thin edge of the wedge — cost-saving measures that may make sense in a business model, but when you’re dealing with mental-health issues, you may be saving dollars, but don’t people count?
Paring back of the outpatient Crisis and Relapse Prevention Service (CRPS) based at Regional Mental Health Care, St. Thomas, accessible to the public and physicians for the past 34 years, is another tragic example of a funding bias on the part of the province.

And it flies in the face of standard business practice based on documented customer satisfaction, stresses James Mendonca, who retired as director of CRPS in St. Thomas in 2003.
In a lengthy conversation this week with City Scope, Mendonca notes the crisis portion of the service housed at Regional Mental Health Care, St. Thomas will soon be eliminated and crisis calls will now be fielded by the local Canadian Mental Health Association office, resulting in a fragmented service in lieu of the multi-disciplinary integrated service that has admirably served St. Thomas and Elgin residents for more than 30 years.
Apparently, the CMHA was the only agency to apply for provincial funding as St. Joseph’s Health Care, London, operator of the St. Thomas mental health care centre, appears to have stepped away from providing primary care services in Elgin.
And although the May 1 start-up date for CMHA to assume responsibility for crisis calls has come and gone, Mendonca argues the new model will duplicate services and is another example of “downsizing mental health services and putting in a Band-Aid service instead. I guess someone thinks they can get away with this in a rural county.”
What is particularly grating to Mendonca are the findings of a study undertaken in 2000 by the Family Practice Research Unit at the University of Western Ontario that found Elgin and Perth counties had Crisis and Relapse Prevention Services that received the best ratings of satisfaction out of 289 family practitioners in six counties in southwestern Ontario.
“This is a rural county,” Mendonca observes. “It’s a service that has been acclaimed as a good model. Don’t dumb them down just because it’s a rural county. It succeeds so well because crisis therapy and relapse prevention interface directly with the family physician. It focuses on keeping people out of the hospital. And if they are admitted, you give them therapy so they’re not re-admitted to hospital. That’s the issue.”
The CRPS offers evidence-based short-term psychotherapy services for a wide variety of mood and anxiety conditions with a multidisciplinary team, he notes. It also offers popular satellite services in West Lorne and Aylmer.
“The intended change will likely replace a one-stop service with a fragmented one for the residents of Elgin county,” he warns.
The CMHA primarily deals with those experiencing severe mental disorders like psychoses, which affect, at most, two per cent of the population.
“Those with depressive and anxiety disorders, which represent at least 15 per cent of the general population, are deprived of funded services for evidence-based treatment and relapse prevention,” he advises.
“Lower-income families with anxiety and depressive disorders who have emergencies are going to get a fragmented service,” he explains.
So what appear to be good-news mental health funding announcements are nothing more than the province “putting money into the community just to serve schizophrenia and serious psychoses,” Mendonca cautions.
“What has happened in London is out-patient services have been drastically cut. When the government is saying they’re putting services into the community, the public doesn’t know the services are for illnesses that have a one to two per cent prevalence rate.”
Mendonca doesn’t begrudge the CMHA funding, but let them attend to those with very serious illnesses he suggests.
“But the rest of the population deserves more appropriate, more suited, more effective therapies,” he stresses. “This is an integration of services. You don’t cut off the first part, where people say, ‘I need help. Oh, go to the CMHA. If you need more help, come to us.’ You can’t do that in a rural catchment area.
“In Elgin, we have this broad-based model already in existence. But people naturally wonder what is going to happen now? Cuts, cuts, cuts — is this the thin edge of the wedge.”
A model, Mendonca adds, that attends to about 1,500 individuals on average each year. Each of those requiring two or three interviews in the process.
He is gratified MPP Steve Peters appears to be sympathetic to his concerns and has recently assured Mendonca he will make enquiries regarding changes to CRPS.
Although a resident of London, Mendonca reminds, “I’m very much a part of the Elgin community.”
And the consulting psychologist will very much remain in close contact with City Scope. In the coming weeks we’ll delve into a proposal that would have funded a service similar to CRPS linked to St. Thomas-Elgin General Hospital.
It was heartily endorsed in 2000 by the Thames Valley District Health Council operating at the time but has since faded into obscurity.

(See also,Loss of mental health beds a “downward spiral” and Loss of mental health care beds and jobs to ensure balanced budget )

Let’s see if we’ve got this right.
As the result of a 4-4 vote, the city pulled the plug on a compassionate grant for a paltry $1,000 earmarked for 15 property owners in the Montgomery Road area who experienced flood damage last year. It’s the third time in recent history they have had to deal with water damage.
Instead, the solution proposed by some members of council entails these residents taking the city to court to sue for damages.
If residents successfully follow this course of action, how many thousands of dollars will this accrue to the city in legal fees and increased insurance premiums?
And this is fiscal responsibility? Or is it a case of stubbornly refusing to concede there may have been liability on the part of the city?
And nowhere in the debate has the mental anguish experienced by these residents been acknowledged.
Ald. Gord Campbell, Ald. Heather Jackson-Chapman, Ald. Bill Aarts and Ald. Lori Baldwin-Sands are the four members of council who, through their non-support of compassionate grants, have challenged residents to settle the matter in court.

“It has not been proven beyond a shadow of a doubt we had some fault.If the city was not at fault, why did we go ahead and do the work (on the sewers).”
Ald. David Warden who voted in favour of compensating victims of flooding last year in the Montgomery Road area.

City Scope appears every Saturday in the Times-Journal. Questions and comments may be e-mailed to:

5 thoughts on “The future of mental health care in St. Thomas-Elgin is the thin edge of the wedge


    “It has not been proven beyond a shadow of a doubt we had some fault.If the city was not at fault, why did we go ahead and do the work (on the sewers).”
    Ald. David Warden who voted in favour of compensating victims of flooding last year in the Montgomery Road area.

    The Residential Municipal Disaster Relief Assistance Program with compensation up to a maximum of $1,000 was what Ald. David Warden supported; too little, too late and nothing more than shallow optics for the Montgomery Area residents.

    If Ald. David Warden is truly concerned and serious about doing right by the Montgomery Area residents, he should bring forward a separate motion to council to remedy that specific situation, without prejudice.

    A motion should be introduced to fully compensate to resolve the Montgomery Area residents for all damages incurred.

    As discussed in council those damages range from just under $1,000 up to about $22,000.

    The repeated flooding is truly an extraordinary circumstance that calls for accountability and leadership.

    I encourage all readers to contact Ald. David Warden and let him know your thoughts. Nothing will happen if you don’t.
    E-mail –
    Phone – 519.631.1349
    Fax – 519.207.0152

    Bill Sandison
    Advocate for a Better Municipal Government
    STR8TALK in St. Thomas

  2. Bill: I don’t know how many times our elected officials have grumbled about things and then never stand up in council chambers to have these matters addressed. For example, no expenses submitted for Mayors Japan trip and the hiring of a waste management person who clearly does not meet the posted requirements. They were all elected with the understanding they are accountable to ratepayers. So start asking questions, we would like to know the answers. Ian

  3. I am one of these residents (Ermatinger Street) and am wanting to take this further, but then at what cost? Stress? Financial? Its hard to know you are doing the right thing by taking it any further

  4. Julie,

    Do not give up. Encourage all the affected area residents to call Alderman Dave Warden, then Alderman Tom Johnston and then the Mayor and ask each of them individually to put forward a motion;

    Without Prejudice;
    that the Montgomery Area residents be fully compensated for all damages related to the repeated flooding damage.

    The worst they can say is no, and it will only take a couple of phone calls. You may still be able to embarrass them into doing the right thing.


  5. Bill:

    Good advice. This is one battle residents should not give up. No where in this debate have I heard council concede these residents have been put through tremendous mental strain, through no fault of their own, and that alone merits compensation.


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