First Article

Introduction:
Welcome to the first “Psych Rehabilitation 4 You” feature article. My original intent was to post an introduction to an article that was to be published in a special edition of the “Journal of Psychiatric and Mental Health Nursing”. I had been writing a chapter for a medical textbook entitled Learning About Mental Health Practice (hardcover preorder or paperback preorder available from Amazon) when my editor invited me to submit an article to the Journal’s special edition. Unfortunately it will not be published due to the peer review process … apparently there isn’t an abundance of crazy composers writing about the creative process and how mental illness bears upon said process … but I digress).

As I said, my original intent for this “introduction” was to serve as a way to present the article to you in this forum: the article deals with creativity and bi-polar disorder and living with mental illness – from my own personal perspective. For anyone interested, there is a brief bibliography at the end of the article. However, I have decided that it is in the best interest of all who may read this to post the article separately, after this post, in order to provide an opportunity for people to have some time to reflect upon the issues raised in an “introduction” that, essentially, does not introduce the article in question.

The reason for this digression is simple enough to explain for it all centres around the recent events at the Royal Ottawa Hospital. Some of what is touched upon here shall be taken developed into a larger article (or, if necessary, articles), particularly the material regarding the economics of health-care and the importance of preventative care (especially within in the realm of mental health). Thank you for visiting. As always, your comments are welcome and encouraged! Enjoy your visit and don’t forget to tell your friends about PsychRehab4You.

My motivation for creating this blog was quite simple: the Psychiatric Rehabilitation Program that had been in operation for over two decades at the Royal Ottawa Hospital (now the Royal Ottawa Health Care Centre) had been given its notice; a date for an execution had been set. You have to understand a few things about Psychiatric Rehabilitation, or PSR as it is usually referred to by those who have come to know it and love it (or, as it were, loathe it). The only thing positive that I can think of to say about PSR is that it is a program that worked in creating a meaningful recovery process in my own life (not to mention the lives of thousands of others), without my having to become an inpatient in a psychiatric ward of an institution.

What, I ask you, could be positive about that? Aside from the fact that PSR works by assisting people with mental illnesses to take an active and substantive role in their progression towards recovery, it also works by providing patients with tools that can assist them in noticing the onset of troubling symptoms, allowing for the possibilities of a medical intervention that may well prevent a full-blown relapse and the subsequent need for a costly hospitalization. Again, that doesn’t indicate that there is anything worth preserving, right? Wrong. Psychiatric Rehabilitation is not, contrary to what the Board of Directors may happen to believe through their deluded sessions, some un-tested “theory” that is going to pass out of “fashion” some day. PSR has been and is being rigorously studied, and it has been established as one of the “best practices” in mental health. Obviously that must be why the Royal Ottawa has decided to move away from it … God forbid “best practices” should be something more than words on a page.

The cost of operating the PSR program ultimately became an impediment to the fulfillment of one of the singularly visionless plans that had heretofore been inflicted upon the ROH community, a plan that could be boiled down to three letters: PPP.

The decision to build a new hospital sparked a great debate over the government’s decision to enter into an unholy alliance with the private sector. While on the surface everyone was told that there would be great economic savings (read: higher costs), and the final outcome would be favorable for all involved (read: maximum suffering with minimal effort), the truth of the matter is far from the silver lined pile of dung that was served up by self serving politicians, replete with pomp and circumstance.

When the new hospital was opened there were so many problems with the building it took weeks… well, no, actually it took months … well, since it’s been a year since they moved in and there are still unresolved issues with the building, I suppose it would be more truthful to say it has been more than a year and the issues are still unresolved. As far as the “economic savings” which this business alliance was to create, that’s too has been revealed as the lie that anyone with a modicum of perception recognized it to be from the beginning. The truth of the matter is that the operating costs of this new hospital are greater than projected, adding one more element in the current $6 million shortfall currently being experienced by the budgetary bean counters at the hospital.

The failure to see that this was a bad decision from the beginning is not the point of this article, however, nor is it my role to castigate those who failed in their capacity as members of the board, for not taking the best interests of the patients to heart (or not even the best interests of the employees of the hospital). Their failure is something that will have to be dealt with at another time.

With only one year having passed since the Royal Ottawa Hospital moved into its new facilities the full ramifications of this “experiment” shall surely not be known for several years to come, but the preliminary consequences can certainly lead us to believe that we have been set upon a path of irrevocable destruction. Change, when sought after in the name of advancing and improving the quality of services provided to patients, is something that the medical community should be striving to achieve, regardless of the costs involved. Unfortunately, the changes that have been taking place at the former Royal Ottawa Hospital have little to do with the best interest of the patients and are primarily focused on the outmoded thinking that there is a price that may be attached to health care; we must change the way we view the entire health-care system, including the economic system and the way it supports the funding of the health-care services.

The recent decision of the Board to not renew the contract of the ROH’s CEO is indicative of the embattled state of affairs that the hospital is experiencing. Decisions have been made to cut programs that save lives; all for the purpose of saving money. Having made the decision to end the PSR Program is going to result in (another) major drain of extraordinarily talented personnel from the hospital who have made the decision to either retire or simply not remain working in an environment that has become overtly hostile to its employees. At the same time that these specialists in Psychiatric Rehabilitation are leaving the hospital … along with their expertise … the hospital has announced (for the second time in four years) that it would still like to have an integrated program of rehabilitation operating throughout the hospital. I suppose they are more interested in the philosophical ideal of rehabilitation rather than its actual practice; once those who are involved in the practice of PSR are no longer around to provide their expertise it will be quite an interesting trick to see to the proliferation of PSR without health-care practitioners who have been trained in its delivery.

This lackadaisical attitude towards the individual recovery process encouraged by PSR did not come as a surprise to Dr Ron Bell, a Psychologist in the PSR Program who has been with the program for over twenty years and helped to establish many of the groups that became fundamental to the success of the program. Commenting on the attitude of the ROH programs, Dr Bell said, “Most of the programs are conservative in the way they support people towards recovery.”

It was quite appropriate when Dr Bell concluded our discussion with the following comment: “You cannot be surprised when organizations make stupid choices.”

I am not surprised … I am deeply grieved. May I point out, for those of you who may only now be gaining consciousness and haven’t been following the simplicity of this chain of thought, that it becomes exponentially difficult to recreate something – say a model of something – when you have thrown out the instructions as to how that “thing” works. Imagine, if you will, a scene at the “Antiques Road Show” … the experts are appraising an extremely beautiful, hand-made, model ship that someone has brought in to be assessed.

The expert is amazed at the quality of the model, by the wonderful details of the rigging, by the detailed carvings along the forecastle and the beautifully preserved painting that hasn’t chipped or peeled after many years. Oddly enough, the appraiser doesn’t seem to mind that there aren’t any instructions along with the model … the reason? The person that made the ship didn’t make it from a “kit”; he made it from “scratch”, without a plan.

We now have the model, and it is beautiful. When the hospital decided that they wanted to spread the beauty of the model throughout the hospital they took the model out of the single unit that it existed in and turned the employees into the PSR “team”, to act as PSR “evangelists” for the entire hospital. At the same time they dismantled the boat. They made the instructions, but dismantled what had been working brilliantly … they didn’t even take a picture of the boat (forgetting it had been a ship).

After a time, by the time the “new” building was ready to be moved into, it became apparent that the instructions weren’t quite good enough … they weren’t clear enough for some people: without a clear picture of what psychiatric rehabilitation is able to accomplish the bean counters found something to be eliminated. This time the instructions were destroyed leaving only a shadow of what there once was; something that only exists in memory, longed for and desired, but in all likelihood gone because they would rather pay for an acute crisis than preventative care.

When the people who leave are gone, taking with them decades of experience working in PSR, we will have lost a resource that cannot be replaced by a dozen newly graduated doctors. It is time to reverse the decisions that are destroying the largest mental health care facility in Eastern Ontario. Future articles shall (attempt to) explore solutions to these issues.

The next article will be: Creativity and Bi-Polar Disorder: Living With Mental Illness

Article and original fractals Copyright © 2007, by Peter Amsel (SOCAN)